CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Mercy

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,886
Cash Discount Price: $2,978
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Mercy is $1,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,978. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.04x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$2,978

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,886

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: $2,978 (321%)

Insurance Median: $1,886 (204%)

Cash: $2,978 (321% of Medicare)

Ins. Median: $1,886 (204% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Upmc Health Plan	$163 - $2,316	18%
UnitedHealthcare	$171	18%
Highmark Wholecare (Prev Gateway)	$220 - $965	24%
Amerihealth Caritas	$235 - $965	25%
Pa Health & Wellness	$253 - $965	27%
Private Health Care Systems	$596	64%
Blue Cross Blue Shield	$730 - $4,521	79%
Upmc Work Partners	$802	87%
Aetna	$939 - $1,986	101%
Cigna	$1,688 - $2,978	182%
Bravo	$1,737	187%
Coventry/First Health	$2,184	236%
Intergroup	$2,482 - $3,971	268%
American Healthcare Group	$3,971	429%
National Provider Network	$4,070	439%
Health Payors Organization	$4,468	482%
Multiplan	$4,468	482%

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 $2,978.
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 Mercy 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.