CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Excela Health Latrobe Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $941
Cash Discount Price: $1,140
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Excela Health Latrobe Hospital is $941. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,140. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.02x the Medicare baseline. Located in One Mellon Way, Latrobe, PA.

Cash / Self-Pay

$1,140

Average discount available for prompt cash payment at this facility.

Insurance Median

$941

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: $1,140 (123%)

Insurance Median: $941 (102%)

Cash: $1,140 (123% of Medicare)

Ins. Median: $941 (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
Geisinger	$337 - $928	36%
Health Partners Plans	$337	36%
Highmark Wholecare	$346 - $963	37%
Upmc	$357 - $954	39%
Amerihealth Caritas	$365 - $928	39%
Pa Health And Wellness	$365 - $945	39%
Upmc For Kids Chip	$414	45%
Highmark Advantage Community Blue	$822	89%
Va	$883	95%
Aetna	$910 - $2,032	98%
Health Partners Plan	$910	98%
Martin'S Point	$910	98%
Peak Health	$910 - $2,076	98%
Humana	$919	99%
United	$919	99%
Senior Life	$927	100%
Cigna	$928 - $2,046	100%
Devoted	$928	100%
The Health Plan Of West Virginia	$936 - $2,076	101%
American Health Plan Of Pa	$972	105%
Provider Network Of America	$972 - $1,520	105%
Provider Plan Partners Plan	$972	105%
Upmc Health Plan	$1,025 - $1,820	111%
Highmark Children'S Health Insurance Program	$1,062	115%
Ambetter / Centene	$1,104	119%
Highmark	$1,195 - $1,949	129%
Velocity	$1,325	143%
Community Blue	$1,754	189%
UnitedHealthcare	$2,362	255%

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 $1,140.
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 Excela Health Latrobe Hospital 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.