CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Jefferson Einstein Philadelphia Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,099
Cash Discount Price: $1,069
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Jefferson Einstein Philadelphia Hospital is $1,099. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,069. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.19x the Medicare baseline. Located in 5501 Old York Road, Philadelphia, PA.

Cash / Self-Pay

$1,069

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,099

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: $1,069 (115%)

Insurance Median: $1,099 (119%)

Cash: $1,069 (115% of Medicare)

Ins. Median: $1,099 (119% 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	$956	103%
United	$975 - $4,789	105%
Cigna	$994 - $4,204	107%
Highmark	$1,004	108%
Upmc	$1,004 - $2,734	108%
Advantra	$1,013	109%
Aetna	$1,013 - $3,654	109%
Geisinger	$1,050 - $3,895	113%
Wellcare	$1,051	113%
Ibc	$1,338 - $9,623	144%

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 $1,069.
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 Jefferson Einstein Philadelphia 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.