CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Francis Hospital-Evanston

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,011

about 1.1× the $927 Medicare rate · typically $928–$1,423

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,016

About the fair price

about $5 over the fair price · 1.1× Medicare

Medicare pays $927 Fair price $1,011 This hospital $1,016 Cash price $967 Hospital's list price $5,378

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $82 Priciest $1,016

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,011 (about 1.1× the $927 Medicare rate). Saint Francis Hospital-Evanston charges insurers about $1,016, or about $967 in cash — about the fair price. Located in Evanston, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$967 - $2,138	104%
Blue Cross Blue Shieldmajor	$919 - $1,354	99%
Aetnamajor	$967 - $2,439	104%
Cignamajor	$488 - $4,550	53%
Humanamajor	$967 - $1,211	104%
Ambetter (Centene)	$1,567	169%
Devoted Health	$967	104%
Health Net	$1,161	125%
HealthPartners	$967 - $1,112	104%
Meridian	$1,016 - $1,272	110%
Molina	$996 - $1,451	107%
WellCare	$967	104%
+ 10 smaller / regional plans	$136 - $1,499

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 967), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Saint Francis Hospital-Evanston is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint Francis Hospital-Evanston

Compare: Upper endoscopy with biopsy at other IL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.