CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Carlisle

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,383
Cash Discount Price: $2,020
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Carlisle is $1,383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,020. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.49x the Medicare baseline. Located in 361 Alexander Spring Road, Carlisle, PA.

Cash / Self-Pay

$2,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,383

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: $2,020 (218%)

Insurance Median: $1,383 (149%)

Cash: $2,020 (218% of Medicare)

Ins. Median: $1,383 (149% 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
Amerihealth Caritas	$189 - $201	20%
Highmark Wholecare (Prev Gateway)	$189	20%
Upmc Health Plan	$193 - $2,356	21%
Health Partners Plans (Jefferson Health Plan)	$202	22%
Geisinger	$216 - $2,431	23%
Pa Health & Wellness	$253 - $969	27%
UnitedHealthcare	$368 - $960	40%
Prime Net	$461 - $2,545	50%
Blue Cross Blue Shield	$673 - $2,803	73%
Keystone Health Plan	$673 - $1,841	73%
Upmc Work Partners	$764	82%
Humana	$897	97%
Aetna	$935 - $1,646	101%
Cigna	$942 - $5,035	102%
Keystone Autism Services	$1,435	155%
Wellspan Population Health	$2,188 - $2,693	236%
Multiplan	$2,861	309%

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 $2,020.
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 Carlisle 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.