CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Milton S Hershey Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,097
Cash Discount Price: $2,019
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Milton S Hershey Medical Center is $1,097. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,019. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.18x the Medicare baseline. Located in 500 University Drive, Hershey, PA.

Cash / Self-Pay

$2,019

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,097

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: $2,019 (218%)

Insurance Median: $1,097 (118%)

Cash: $2,019 (218% of Medicare)

Ins. Median: $1,097 (118% 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]	$818 - $962	88%
[Highmark Wholecare]	$818 - $962	88%
[Geisinger]	$866 - $4,541	93%
[Health Partners Plans]	$895 - $981	97%
[Pa Health & Wellness]	$899 - $991	97%
[Highmark]	$952 - $5,173	103%
Aetna	$972 - $4,127	105%
Humana	$972	105%
[Healthspring]	$972	105%
UnitedHealthcare	$981 - $4,394	106%
[Upmc]	$981 - $4,502	106%
[Cbc]	$1,097 - $4,036	118%
[Point Comfort Underwriters]	$1,202	130%
[Highmark Aca]	$3,621	391%
Cigna	$3,896	420%
[Highmark Choice Blue]	$4,138	447%
[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 $2,019.
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 Milton S Hershey Medical 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.