CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Penn State Health Lancaster Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $912
Cash Discount Price: $1,767
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Penn State Health Lancaster Medical Center is $912. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,767. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.98x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$1,767

Average discount available for prompt cash payment at this facility.

Insurance Median

$912

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: $1,767 (191%)

Insurance Median: $912 (98%)

Cash: $1,767 (191% of Medicare)

Ins. Median: $912 (98% 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]	$756 - $890	82%
[Highmark Wholecare]	$756 - $890	82%
[Geisinger]	$801 - $4,061	86%
[Health Partners Plans]	$828 - $908	89%
[Pa Health & Wellness]	$832 - $917	90%
[Highmark]	$881 - $3,890	95%
UnitedHealthcare	$890 - $3,815	96%
[Cbc]	$890 - $3,066	96%
Aetna	$899 - $3,662	97%
Humana	$899	97%
[Healthspring]	$899	97%
[Upmc]	$908 - $4,502	98%
[Point Comfort Underwriters]	$1,112	120%
[Highmark Choice Blue]	$3,112	336%
[Highmark Aca]	$3,267	353%
Cigna	$3,739	404%
[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 $1,767.
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 Lancaster 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.