CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Hamot

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,474
Cash Discount Price: $3,124
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Hamot is $1,474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,124. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.59x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$3,124

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,474

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: $3,124 (337%)

Insurance Median: $1,474 (159%)

Cash: $3,124 (337% of Medicare)

Ins. Median: $1,474 (159% 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
Upmc Health Plan	$163 - $2,876	18%
UnitedHealthcare	$171 - $1,535	18%
Aetna	$178 - $3,645	19%
Geisinger	$207	22%
Highmark Wholecare (Prev Gateway)	$220 - $1,114	24%
Health Partners Plans (Jefferson Health Plan)	$224	24%
Amerihealth Caritas	$232 - $1,114	25%
Pa Health & Wellness	$253 - $1,114	27%
Blue Cross Blue Shield	$730 - $3,528	79%
Upmc Work Partners	$757	82%
Univera	$781 - $2,291	84%
Fidelis	$1,032	111%
Wellcare	$1,063	115%
Cigna	$1,114 - $2,083	120%
Independent Health	$1,300 - $1,413	140%
Intergroup	$3,385 - $4,166	365%
Multiplan	$3,645 - $4,166	393%

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 $3,124.
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 Hamot 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.