CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $947
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Independence Health System Butler Memorial Hospita is $947. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.02x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$947

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%)

Insurance Median: $947 (102%)

Ins. Median: $947 (102% 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
Medicaid / KanCare	$149	16%
UnitedHealthcare	$149 - $2,313	16%
Geisinger	$162 - $947	17%
Amerihealth	$163 - $947	18%
Jefferson Health Plan	$163	18%
Gateway	$168 - $1,013	18%
Upmc	$168 - $1,820	18%
Aetna	$171 - $2,074	18%
Ccbh - Behavioral Health	$390	42%
Pnoa	$760 - $992	82%
Workers Comp	$841	91%
Highmark	$884 - $1,903	95%
Life Butler County	$902	97%
Martin'S Point - Usfhp	$902	97%
Medicare (plans)	$902	97%
Peak Health	$902 - $2,120	97%
Provider Partners	$902	97%
Tricare	$902	97%
Humana	$938	101%
Devoted Health Plan	$956	103%
The Health Plan	$956 - $2,120	103%
Pa Health & Wellness	$965	104%
American Health Plan	$992	107%
Highmark Aca - Direct Blue	$1,189	128%
Ellwood Group	$1,804	195%
Highmark Community Blue	$1,865	201%
Cigna	$2,061	222%
Highmark - Ind.& Managed Care	$2,114	228%

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 $X.
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 Independence Health System Butler Memorial Hospita 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.