CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Mercy

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$896

about 1.0× the $927 Medicare rate · typically $398–$1,014

modeled estimate · not a bill or quote

What this hospital charges insurers

$939

About the fair price

about $43 over the fair price · 1.0× Medicare

Medicare pays $927 Fair price $896 This hospital $939 Cash price $2,978 Hospital's list price $4,964

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $147 Priciest $939

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $896 (about 1.0× the $927 Medicare rate). UPMC Mercy charges insurers about $939, or about $2,978 in cash — about the fair price. Located in Pittsburgh, PA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$171	18%
Blue Cross Blue Shieldmajor	$220 - $4,521	24%
Aetnamajor	$939 - $1,986	101%
Cignamajor	$1,688 - $2,978	182%
AmeriHealth	$235 - $965	25%
UPMC Health Plan	$163 - $2,316	18%
+ 7 smaller / regional plans	$253 - $4,468

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,978), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm UPMC Mercy is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UPMC Mercy

Compare: Upper endoscopy with biopsy at other PA hospitals

Reading Hospital · West Reading $147
Titusville Area Hospital · Titusville $161
UPMC Wellsboro · Wellsboro $166
UPMC Muncy · Muncy $168
Uniontown Hospital · Uniontown $210
Allegheny Valley Hospital · Natrona $218
Allegheny General Hospital · Pittsburgh $218
Canonsburg General Hospital · Canonsburg $218

Insurance negotiated median for the same procedure, sorted lowest first.