CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Altoona

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $965
Cash Discount Price: $1,676
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Altoona is $965. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,676. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.04x the Medicare baseline. Located in 620 Howard Avenue, Altoona, PA.

Cash / Self-Pay

$1,676

Average discount available for prompt cash payment at this facility.

Insurance Median

$965

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: $1,676 (181%)

Insurance Median: $965 (104%)

Cash: $1,676 (181% of Medicare)

Ins. Median: $965 (104% 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
Aetna	$149 - $1,480	16%
UnitedHealthcare	$156 - $1,432	17%
Upmc Health Plan	$163 - $2,524	18%
Geisinger	$207 - $1,536	22%
Highmark Wholecare (Prev Gateway)	$220 - $965	24%
Health Partners Plans (Jefferson Health Plan)	$224	24%
Amerihealth Caritas	$232 - $965	25%
Pa Health & Wellness	$253 - $965	27%
Blue Cross Blue Shield	$730	79%
Upmc Work Partners	$730	79%
Cigna	$965 - $1,396	104%
Preferred Healthcare System	$1,396	151%
Private Health Care Systems	$2,234	241%

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 $1,676.
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 Altoona 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.