Upper endoscopy with biopsy
Facility: Hospital of Univ of Pennsylvania
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,933
- Cash Discount Price: $4,134
- vs. Medicare Baseline: 2.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 209% of the Medicare baseline (a markup of 109%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $253 - $4,134 | 27% |
| Medicaid / KanCare | $275 - $4,134 | 30% |
| Pa Medical Assistance | $281 - $4,134 | 30% |
| Kaiser Permanente | $295 - $4,134 | 32% |
| Keystone Mercy Health Plan | $360 - $4,134 | 39% |
| Paired Kidney Exchange | $413 | 45% |
| Gspp And Wissahickon Hospice | $477 | 51% |
| UnitedHealthcare | $554 - $4,134 | 60% |
| Horizon Nj Health | $699 - $727 | 75% |
| Health Partners | $715 - $4,134 | 77% |
| Preferred Health Care Eliance | $909 | 98% |
| Pgm - Regie De L'Assurance Maladie Quebec | $951 | 103% |
| Blue Cross Blue Shield | $953 - $20,526 | 103% |
| Medicare (plans) | $953 - $972 | 103% |
| Philadelphia Va Medical Center | $953 | 103% |
| Tricare | $953 | 103% |
| Ibc | $972 | 105% |
| Cigna | $982 - $4,326 | 106% |
| Geisinger Health Plan | $982 - $3,023 | 106% |
| Humana | $982 - $3,307 | 106% |
| Devoted Health | $1,001 | 108% |
| Pa Health And Wellness | $1,001 - $1,573 | 108% |
| Penn Life (Living Independently For Elders) | $1,001 | 108% |
| Aetna | $1,011 - $4,134 | 109% |
| Clover Health Plan | $1,030 | 111% |
| Keystone First | $1,058 | 114% |
| Us Family Health Plan | $1,096 | 118% |
| Gateway Health Plan | $1,182 | 128% |
| Elap | $1,354 | 146% |
| Pgm - Kuwait Defense | $1,447 - $1,860 | 156% |
| Claims Watcher | $1,525 - $1,716 | 165% |
| Qualcare | $1,571 | 170% |
| Oscar Health Plan | $1,621 | 175% |
| Olympus | $1,625 | 175% |
| Coventry | $1,654 - $2,108 | 178% |
| Pgm - Chop | $1,654 | 178% |
| Wissahickon Hospice | $1,654 | 178% |
| Centivo | $1,716 | 185% |
| Elap Services | $1,773 | 191% |
| Healthamerica/Coventry | $1,860 - $2,026 | 201% |
| Highmark | $2,005 | 216% |
| First Health Global | $2,067 | 223% |
| Health Net | $2,480 | 268% |
| Pgm - Royal Embassy Of Saudi Arabia | $2,480 | 268% |
| Penn Global Medicine | $2,526 | 273% |
| Pgm - Embassy Of Qatar | $2,687 | 290% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $2,687 | 290% |
| Interlink | $2,770 | 299% |
| Pgm - Embassy Of The United Emirates/Ipc | $2,894 | 312% |
| Health America/Ccn | $3,307 | 357% |
| Intergroup | $3,307 | 357% |
| Pgm - Kuwait Health Division | $3,307 | 357% |
| Pgm - Kuwait Oil | $3,307 | 357% |
| Preferred Care | $3,307 | 357% |
| Ibc Commercial Hpn | $3,417 | 369% |
| Keystone Hmo Proactive | $3,891 | 420% |
| Blue Quality Centers For Transplant (Bqct) | $4,134 | 446% |
| City Of Philadelphia Behavioral Health | $4,134 | 446% |
| Commercial Other | $4,134 | 446% |
| International Pfs | $4,134 | 446% |
| United Behavioral Health | $4,134 | 446% |
| Workers Compensation | $4,134 | 446% |