CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Northwestern Medicine McHenry

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,239
Cash Discount Price: $7,163
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Northwestern Medicine McHenry is $2,239. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,163. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.42x the Medicare baseline. Located in 4201 Medical Center Drive, McHenry, IL.

Cash / Self-Pay

$7,163

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,239

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: $7,163 (773%)

Insurance Median: $2,239 (242%)

Cash: $7,163 (773% of Medicare)

Ins. Median: $2,239 (242% 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 242% of the Medicare baseline (a markup of 142%). 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
Aetna	$887 - $2,413	96%
Cigna	$906 - $3,448	98%
Mercy Care Health Plans [5013]	$1,395	151%
Blue Cross Blue Shield	$1,558 - $4,597	168%
UnitedHealthcare	$2,137 - $2,374	231%
Healthlink [125]	$2,298	248%
Choicecare [177]	$2,446	264%
The Alliance [1703]	$2,953	319%
Health'S Finest Network [126]	$3,218 - $3,356	347%
Beechstreet [176]	$3,678	397%
Multiplan/Phcs [142]	$4,597 - $9,102	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 $7,163.
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 Northwestern Medicine McHenry 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.