CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Palos Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,953
Cash Discount Price: $6,344
vs. Medicare Baseline: 3.19x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Palos Community Hospital is $2,953. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,344. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.19x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$6,344

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,953

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: $6,344 (685%)

Insurance Median: $2,953 (319%)

Cash: $6,344 (685% of Medicare)

Ins. Median: $2,953 (319% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 319% of the Medicare baseline (a markup of 219%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$736 - $4,597	79%
Cigna	$860 - $4,597	93%
Aetna	$988 - $4,597	107%
First Health Plan [6034]	$1,940 - $3,448	209%
UnitedHealthcare	$2,137 - $4,597	231%
Carelon Behavioral Health [159]	$2,298	248%
Healthlink [125]	$2,298 - $4,597	248%
Magellan Behavioral Hlth [136]	$2,758	298%
The Alliance [1703]	$2,953	319%
Multiplan/Phcs [142]	$3,218 - $4,597	347%
Compsych [112]	$3,448	372%
Beechstreet [176]	$3,678	397%
Health'S Finest Network [126]	$3,907	422%
Galaxy Health Network [220]	$4,597	496%
Global Excel [1712]	$4,597	496%
Health Alliance [181]	$4,597	496%

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 $6,344.
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 Palos Community 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.