CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Hanover

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,242
Cash Discount Price: $2,020
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Hanover is $1,242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,020. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.34x the Medicare baseline. Located in 300 Highland Ave, Hanover, PA.

Cash / Self-Pay

$2,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,242

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: $2,020 (218%)

Insurance Median: $1,242 (134%)

Cash: $2,020 (218% of Medicare)

Ins. Median: $1,242 (134% 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
Amerihealth Caritas	$189 - $201	20%
Highmark Wholecare (Prev Gateway)	$189	20%
Upmc Health Plan	$193 - $2,356	21%
Health Partners Plans (Jefferson Health Plan)	$202	22%
Geisinger	$216 - $2,431	23%
Pa Health & Wellness	$253 - $967	27%
UnitedHealthcare	$368 - $958	40%
Blue Cross Blue Shield	$640 - $3,186	69%
Keystone Health Plan	$640 - $2,288	69%
Upmc Work Partners	$720	78%
Prime Net	$815 - $1,050	88%
Humana	$896	97%
Aetna	$934 - $2,450	101%
Cigna	$940 - $5,035	101%
Keystone Autism Services	$1,433	155%
Carefirst	$2,861	309%
Multiplan	$2,861	309%
Wellspan Population Health	$2,928	316%

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 $2,020.
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 Hanover 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.