CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Reading Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $155
Cash Discount Price: $286
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Reading Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $286. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.17x the Medicare baseline. Located in 420 S 5Th Avenue, West Reading, PA.

Cash / Self-Pay

$286

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $286 (31%)

Insurance Median: $155 (17%)

Cash: $286 (31% of Medicare)

Ins. Median: $155 (17% 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
Humana	$101 - $123	11%
UnitedHealthcare	$117 - $203	13%
Blue Cross Blue Shield	$118 - $331	13%
Highmark	$119 - $169	13%
Upmc	$119 - $178	13%
Amerihealth Caritas	$120 - $240	13%
Aetna	$123 - $469	13%
Health America	$123	13%
Devoted Health	$124	13%
Geisinger	$124 - $195	13%
Health Partners	$125 - $200	13%
Pa Health & Wellness	$125 - $201	13%
Gateway	$127 - $190	14%
Lehigh Valley Health Network	$184	20%
Cigna	$224	24%
First Health	$506	55%

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 $286.
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 Reading 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.