CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mc Donough District Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,210
Cash Discount Price: $1,244
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mc Donough District Hospital is $1,210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,244. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.31x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$1,244

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,210

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: $1,244 (134%)

Insurance Median: $1,210 (131%)

Cash: $1,244 (134% of Medicare)

Ins. Median: $1,210 (131% 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
Health Alliance	$79 - $1,845	9%
Hfn	$123 - $1,866	13%
UnitedHealthcare	$123 - $1,866	13%
Aetna	$132 - $2,073	14%
Humana	$132 - $1,866	14%
Medicaid / KanCare	$132 - $2,073	14%
Medicare (plans)	$132 - $1,047	14%
Meridian	$132 - $1,047	14%
Molina	$132 - $2,073	14%
Mutual Medical	$132 - $2,073	14%
Veteran Affairs	$132 - $1,047	14%
Tricare	$977	105%
Blue Cross Blue Shield	$1,210 - $2,073	131%
Springfield Health	$1,700	183%
Consociate	$1,762	190%
Trilogy	$1,762	190%
Blue Choice	$1,866	201%
Current Health	$1,866	201%
Healthlink	$1,866 - $1,949	201%
Preferred Plan	$1,969	212%

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 $1,244.
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 Mc Donough District 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.