CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hospital of the Fox Chase Cancer Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,146
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hospital of the Fox Chase Cancer Center is $1,146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.24x the Medicare baseline. Located in 333 Cottman Avenue, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,146

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%)

Insurance Median: $1,146 (124%)

Ins. Median: $1,146 (124% 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
Keystone First	$239 - $1,137	26%
Pennsylvania Health And Wellness	$332 - $2,834	36%
Upmc Health Plan	$505 - $1,146	54%
Blue Cross Blue Shield	$932 - $3,207	101%
Humana	$932	101%
Health Partners Plans	$950 - $1,670	103%
Clover Health	$988	107%
UnitedHealthcare	$1,012	109%
Elder Health	$1,118	121%
Cigna	$1,127	122%
Innovage	$1,127	122%
Aetna	$1,174 - $6,316	127%
Wtc Health Program	$1,242	134%
Oscar Health	$1,398	151%
Prime Health Services	$1,483	160%
Qualcare	$3,923	423%

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 $X.
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 Hospital of the Fox Chase Cancer Center 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.