CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Pinnacle Hospitals

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,201
Cash Discount Price: $2,051
vs. Medicare Baseline: 2.38x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Pinnacle Hospitals is $2,201. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,051. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.38x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$2,051

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,201

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: $2,051 (221%)

Insurance Median: $2,201 (238%)

Cash: $2,051 (221% of Medicare)

Ins. Median: $2,201 (238% 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 238% of the Medicare baseline (a markup of 138%). 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
Amerihealth Caritas	$189 - $201	20%
Health Partners Plans (Jefferson Health Plan)	$202	22%
Geisinger	$216	23%
Pa Health & Wellness	$253 - $996	27%
UnitedHealthcare	$368 - $987	40%
Blue Cross Blue Shield	$673 - $3,012	73%
Keystone Health Plan	$673 - $2,201	73%
Upmc Work Partners	$720	78%
Prime Net	$815 - $2,611	88%
Humana	$950	103%
Aetna	$962 - $3,485	104%
Cigna	$968	104%
Intergroup	$2,188 - $2,951	236%
Upmc Health Plan	$2,316	250%
Wellspan Population Health	$2,861 - $2,951	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 $2,051.
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 Pinnacle Hospitals 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.