CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Vincent Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $233
Cash Discount Price: $69
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Vincent Hospital is $233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.25x the Medicare baseline. Located in 232 West 25Th Street, Erie, PA.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$233

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: $69 (7%)

Insurance Median: $233 (25%)

Cash: $69 (7% of Medicare)

Ins. Median: $233 (25% 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	$112 - $164	12%
Highmark	$119 - $1,488	13%
Life Pittsburgh	$128 - $1,020	14%
Medicare (plans)	$135 - $1,051	15%
American Health Plans	$140 - $1,020	15%
Amerihealth	$156 - $1,071	17%
Aetna	$163 - $2,077	18%
University Of Pittsburgh Medical Center	$171 - $1,560	18%
Pennsylvania Health And Wellness	$196 - $422	21%
Highmark Wholecare	$205 - $1,081	22%
Geisinger	$215 - $450	23%
UnitedHealthcare	$215 - $27,552	23%
Cigna	$218 - $2,176	24%
Jefferson Health Plans	$227 - $430	24%
Martin'S Point	$1,020	110%
Blue Cross Blue Shield	$1,071 - $1,608	116%
Humana	$1,081	117%
Molina	$1,112	120%
Medical Mutual	$2,176	235%

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 $69.
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 Saint Vincent Hospital 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.