CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Geisinger-Lewistown Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,758
Cash Discount Price: $2,243
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Geisinger-Lewistown Hospital is $1,758. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,243. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.90x the Medicare baseline. Located in 400 Highland Avenue, Lewistown, PA.

Cash / Self-Pay

$2,243

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,758

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: $2,243 (242%)

Insurance Median: $1,758 (190%)

Cash: $2,243 (242% of Medicare)

Ins. Median: $1,758 (190% 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
Medicaid / KanCare	$149	16%
Geisinger Family Plan	$159	17%
Amerihealth	$163	18%
Upmc Health Plan	$175 - $11,890	19%
Health Partners	$178	19%
Upmc Chip	$186	20%
Blue Cross Blue Shield	$909 - $2,743	98%
Geisinger Health Plan	$909 - $4,262	98%
Medicare (plans)	$909	98%
Advantra	$918	99%
Humana	$918	99%
Aetna	$1,478 - $1,758	160%
Cigna	$1,565 - $1,903	169%
UnitedHealthcare	$1,603	173%
Christian Healthcare Ministries	$1,809	195%
Ambetter / Centene	$2,182	235%
Christian Health Aid	$2,894	312%
Three Rivers Provider Network Inc.	$2,894	312%
Multiplan	$3,075	332%
Healthsmart Payors Organization	$3,256	351%

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 $2,243.
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 Geisinger-Lewistown 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.