Upper endoscopy with biopsy
Facility: Pennsylvania Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,137
- Cash Discount Price: $4,273
- vs. Medicare Baseline: 2.31x 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 231% of the Medicare baseline (a markup of 131%). 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 |
|---|---|---|
| Keystone Mercy Health Plan | $190 | 21% |
| Upmc | $253 - $4,273 | 27% |
| Medicaid / KanCare | $275 - $4,273 | 30% |
| Gateway Health Plan | $281 - $1,176 | 30% |
| Pa Medical Assistance | $281 | 30% |
| UnitedHealthcare | $554 - $4,273 | 60% |
| Health Partners | $711 - $4,273 | 77% |
| Horizon Nj Health | $722 - $751 | 78% |
| Blue Cross Blue Shield | $949 - $20,526 | 102% |
| Medicare (plans) | $949 - $968 | 102% |
| Philadelphia Va Medical Center | $949 | 102% |
| Tricare | $953 | 103% |
| Ibc | $968 | 104% |
| Cigna | $977 - $4,326 | 105% |
| Geisinger Health Plan | $977 - $3,009 | 105% |
| Humana | $977 - $3,418 | 105% |
| Pgm - Regie De L'Assurance Maladie Quebec | $983 | 106% |
| Pa Health And Wellness | $996 - $1,565 | 107% |
| Penn Life (Living Independently For Elders) | $996 | 107% |
| Aetna | $1,006 - $4,273 | 109% |
| Clover Health Plan | $1,025 | 111% |
| Keystone First | $1,053 | 114% |
| Us Family Health Plan | $1,096 | 118% |
| Preferred Health Care Eliance | $1,111 | 120% |
| Elap | $1,347 | 145% |
| Pgm - Kuwait Defense | $1,496 - $1,923 | 161% |
| Claims Watcher | $1,518 - $1,708 | 164% |
| Oscar Health Plan | $1,613 | 174% |
| Devon | $1,624 - $1,923 | 175% |
| Qualcare | $1,624 | 175% |
| Centivo | $1,708 | 184% |
| Coventry | $1,709 - $2,179 | 184% |
| Pgm - Chop | $1,709 | 184% |
| Wissahickon Hospice | $1,709 | 184% |
| Elap Services | $1,764 | 190% |
| Healthamerica/Coventry | $1,923 - $2,094 | 208% |
| Highmark | $1,995 | 215% |
| Olympus | $2,077 | 224% |
| First Health Global | $2,136 | 231% |
| Urn-Cancer Resource Services | $2,136 | 231% |
| Penn Global Medicine | $2,514 | 271% |
| Health Net | $2,564 | 277% |
| Pgm - Royal Embassy Of Saudi Arabia | $2,564 | 277% |
| Pgm - Embassy Of Qatar | $2,777 | 300% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $2,777 | 300% |
| Pgm - Embassy Of The United Emirates/Ipc | $2,991 | 323% |
| Ibc Commercial Hpn | $3,417 | 369% |
| Devon Health Services Inc | $3,418 | 369% |
| Health America/Ccn | $3,418 | 369% |
| Intergroup | $3,418 | 369% |
| Pgm - Kuwait Health Division | $3,418 | 369% |
| Pgm - Kuwait Oil | $3,418 | 369% |
| Preferred Care | $3,418 | 369% |
| Keystone Hmo Proactive | $3,891 | 420% |
| Commercial Other | $4,273 | 461% |
| Community Behavioral Health | $4,273 | 461% |
| International Pfs | $4,273 | 461% |
| Quest Behavioral Health | $4,273 | 461% |
| United Behavioral Health | $4,273 | 461% |
| Workers Compensation | $4,273 | 461% |