CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Penn State Health St. Joseph

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,052
Cash Discount Price: $1,585
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Penn State Health St. Joseph is $1,052. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,585. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.14x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$1,585

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,052

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: $1,585 (171%)

Insurance Median: $1,052 (114%)

Cash: $1,585 (171% of Medicare)

Ins. Median: $1,052 (114% 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
[Amerihealth Caritas]	$784 - $922	85%
[Highmark Wholecare]	$784 - $922	85%
[Geisinger]	$830 - $4,396	90%
[Health Partners Plans]	$858 - $941	93%
[Pa Health & Wellness]	$862 - $950	93%
[Highmark]	$913 - $5,014	99%
UnitedHealthcare	$922 - $4,126	100%
[Cbc]	$922 - $3,221	100%
[Ibc]	$922 - $3,029	100%
Aetna	$932 - $3,113	101%
Humana	$932	101%
[Healthspring]	$932	101%
[Upmc]	$941 - $4,502	102%
[Point Comfort Underwriters]	$1,153	124%
Cigna	$3,739	404%
[Highmark Choice Blue]	$4,011	433%
[Highmark Aca]	$4,211	454%
[Preferred Healthcare Systems]	$4,570	493%
[First Health]	$4,875	526%
[Multiplan]	$4,875	526%

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 $1,585.
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 Penn State Health St. Joseph 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.