CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Wellsboro

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,571
Cash Discount Price: $3,895
vs. Medicare Baseline: 3.85x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Wellsboro is $3,571. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,895. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.85x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$3,895

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,571

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: $3,895 (420%)

Insurance Median: $3,571 (385%)

Cash: $3,895 (420% of Medicare)

Ins. Median: $3,571 (385% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 385% of the Medicare baseline (a markup of 285%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$163	18%
Geisinger	$163 - $3,938	18%
Upmc Health Plan	$163 - $2,562	18%
Highmark Wholecare (Prev Gateway)	$166 - $1,175	18%
Health Partners Plans (Jefferson Health Plan)	$224	24%
Pa Health & Wellness	$253 - $1,269	27%
UnitedHealthcare	$360 - $4,995	39%
Upmc Work Partners	$730	79%
Aetna	$959 - $5,072	103%
Blue Cross Blue Shield	$1,066 - $2,972	115%
Cigna	$1,119 - $1,234	121%
Wirerope Works	$2,963 - $3,268	320%
Multiplan	$4,157 - $5,583	449%
America'S Choice	$4,797 - $5,289	518%
Intergroup	$4,797 - $5,289	518%

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 $3,895.
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 Wellsboro 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.