CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ahn Wexford Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $230
Cash Discount Price: $100
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ahn Wexford Hospital is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.25x the Medicare baseline. Located in 12351 Perry Highway, Wexford, PA.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $100 (11%)

Insurance Median: $230 (25%)

Cash: $100 (11% of Medicare)

Ins. Median: $230 (25% 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
Highmark	$119 - $1,796	13%
Life Pittsburgh	$128 - $902	14%
Medicare (plans)	$135 - $929	15%
American Health Plans	$140 - $902	15%
Amerihealth	$156 - $947	17%
Pennsylvania Health And Wellness	$196 - $422	21%
Highmark Wholecare	$205 - $956	22%
Geisinger	$215 - $450	23%
UnitedHealthcare	$215 - $2,997	23%
Cigna	$218 - $2,993	24%
Martin'S Point	$902	97%
Aetna	$938 - $2,742	101%
Humana	$956	103%
Molina	$983	106%
Medical Mutual	$2,993	323%

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 $100.
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 Ahn Wexford 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.