CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Chautauqua at Wca

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,210
Cash Discount Price: $1,153
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Chautauqua at Wca is $1,210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,153. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.31x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$1,153

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,210

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)

Cash / Self-Pay: $1,153 (124%)

Insurance Median: $1,210 (131%)

Cash: $1,153 (124% of Medicare)

Ins. Median: $1,210 (131% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $926.63 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Univera	$115 - $1,342	12%
Upmc Health Plan	$186 - $1,168	20%
Geisinger	$207	22%
Health Partners Plans (Jefferson Health Plan)	$224	24%
Magnacare	$555 - $1,441	60%
Blue Cross Blue Shield	$1,034 - $1,987	112%
Independent Health	$1,085 - $1,412	117%
Beacon	$1,146 - $1,432	124%
Fidelis	$1,146	124%
Humana	$1,146 - $1,537	124%
United Behavioral Health	$1,146	124%
UnitedHealthcare	$1,146 - $1,249	124%
Wellcare	$1,180	127%
Aetna	$1,191 - $1,249	129%
Multiplan	$1,441	156%
Ghi/Emblem Health	$1,537	166%
Statewide Independent Ppo	$1,690	182%
Affordable First Health	$1,729	187%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,153.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Chautauqua at Wca is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.