CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,323
Cash Discount Price: $2,966
vs. Medicare Baseline: 2.51x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UPMC Children's Hospital of Pittsburgh is $2,323. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,966. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.51x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$2,966

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,323

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: $2,966 (320%)

Insurance Median: $2,323 (251%)

Cash: $2,966 (320% of Medicare)

Ins. Median: $2,323 (251% 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 251% of the Medicare baseline (a markup of 151%). 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
Aetna	$140 - $2,719	15%
Upmc Health Plan	$343 - $2,874	37%
Health Plan Of Upper Ohio Valley	$517 - $3,213	56%
Amerihealth Caritas	$556 - $965	60%
Health Partners Plans (Jefferson Health Plan)	$575	62%
Highmark Wholecare (Prev Gateway)	$600	65%
Pa Health & Wellness	$602	65%
Geisinger	$611 - $2,222	66%
Blue Cross Blue Shield	$948 - $3,125	102%
Cigna	$965 - $2,719	104%
UnitedHealthcare	$1,116 - $2,323	120%
Intergroup	$3,213 - $4,202	347%
Coventry/First Health	$3,954	427%
Saudi Armed Forces	$3,954	427%
Health Payors Organization	$4,202	453%
Multiplan	$4,202	453%
National Provider Network	$4,449	480%
Private Health Care Systems	$4,449	480%

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 $2,966.
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 Children's Hospital of Pittsburgh 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.