CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Somerset

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$567

about 0.6× the $927 Medicare rate · typically $280–$1,061

modeled estimate · not a bill or quote

What this hospital charges insurers

$894

Above the fair price

about $327 over the fair price · 1.0× Medicare

Medicare pays $927 Fair price $567 This hospital $894 Cash price $2,051 Hospital's list price $3,419

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 $894

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

A fair price for a Upper endoscopy with biopsy is about $567 (about 0.6× the $927 Medicare rate). UPMC Somerset charges insurers about $894, or about $2,051 in cash — above the fair price. Located in Somerset, PA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $567. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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✓ Humana CignaKaiser 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	$323 - $1,496	35%
Blue Cross Blue Shieldmajor	$191 - $1,678	21%
Aetnamajor	$1,346 - $1,389	145%
Humanamajor	$2,524 - $2,604	272%
AmeriHealth	$171 - $894	18%
Geisinger	$207 - $1,367	22%
UPMC Health Plan	$163 - $2,937	18%

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 2,051), 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 Somerset 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 Somerset

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.