CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Geisinger Jersey Shore Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $441
Cash Discount Price: $563
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Geisinger Jersey Shore Hospital is $441. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $563. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.48x the Medicare baseline. Located in 1020 Thompson Street, Jersey Shore, PA.

Cash / Self-Pay

$563

Average discount available for prompt cash payment at this facility.

Insurance Median

$441

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: $563 (61%)

Insurance Median: $441 (48%)

Cash: $563 (61% of Medicare)

Ins. Median: $441 (48% 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
Blue Cross Blue Shield	$146 - $539	16%
Medicaid / KanCare	$149	16%
Amerihealth	$163	18%
Geisinger Family Plan	$163	18%
Upmc For You	$175	19%
Health Partners	$178	19%
Geisinger Health Plan	$182 - $446	20%
Upmc Chip	$186	20%
Advantra	$375	40%
Aetna	$375 - $695	40%
American Progressive	$375	40%
Medicare (plans)	$375	40%
Humana	$379	41%
UnitedHealthcare	$403	43%
Cigna	$436	47%
Christian Healthcare Ministries	$454	49%
Medical Development International	$636	69%
Integrated Health Plan	$681	73%
Prime Health Services	$681	73%
Multiplan	$726	78%
Ambetter / Centene	$900	97%
Prison Health Services	$1,114	120%

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 $563.
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 Geisinger Jersey Shore 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.