CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Horizon

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,610
Cash Discount Price: $2,476
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Horizon is $1,610. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,476. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.74x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$2,476

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,610

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: $2,476 (267%)

Insurance Median: $1,610 (174%)

Cash: $2,476 (267% of Medicare)

Ins. Median: $1,610 (174% 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	$163 - $2,476	18%
Upmc Health Plan	$163 - $2,316	18%
Geisinger	$207	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%
Upmc Work Partners	$688	74%
Blue Cross Blue Shield	$699 - $1,882	75%
UnitedHealthcare	$939 - $1,651	101%
Cigna	$965 - $1,651	104%
Intergroup	$2,683	290%
Coventry/First Health	$2,724	294%
Health Coalition Partners	$2,889	312%
Private Health Care Systems	$3,302	356%
Prime Net	$3,384	365%
Humana	$3,508	379%

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 $2,476.
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 Horizon 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.