CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Fhn Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,369
Cash Discount Price: $2,648
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Fhn Memorial Hospital is $1,369. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,648. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.48x the Medicare baseline. Located in 1045 West Stephenson Street, Freeport, IL.

Cash / Self-Pay

$2,648

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,369

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: $2,648 (286%)

Insurance Median: $1,369 (148%)

Cash: $2,648 (286% of Medicare)

Ins. Median: $1,369 (148% 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
Aetna	$125 - $1,854	13%
Health Alliance Mcr Adv	$125 - $972	13%
Humana	$125 - $2,633	13%
Quartz Mcr Adv	$125 - $972	13%
UnitedHealthcare	$125 - $2,596	13%
Osf Healthplans - All Plans	$176 - $3,328	19%
Blue Cross Blue Shield	$289 - $2,247	31%
Meridian Health Plan - All Plans	$344 - $836	37%
The Alliance - All Plans	$369 - $1,995	40%
Ecoh Nihp	$697 - $2,097	75%
Ecoh - All Other Plans	$766 - $2,263	83%
Nihp Employ - All Plans	$766 - $2,097	83%
Quartz - All Other Plans	$878 - $2,163	95%
Northern Il Hp - All Plans	$1,010 - $2,296	109%
First Health - All Plans	$1,029 - $2,340	111%
Hfn - All Plans	$1,200 - $2,729	130%
First Choice Il - All Plans	$1,244 - $2,829	134%
Multiplan Phcs - All Plans	$1,244 - $2,829	134%
Wps - All Plans	$1,280 - $2,909	138%
Galaxy - All Plans	$1,318 - $2,995	142%
Health Alliance - All Other Plans	$1,318 - $2,995	142%
Interplan Health - All Plans	$1,318 - $2,995	142%
Midland Choice - All Plans	$1,318 - $3,162	142%
Preferred Plan Ppo - All Plans	$1,318 - $2,995	142%
Trustmark - All Plans	$1,347 - $3,062	145%

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 $2,648.
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 Fhn Memorial 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.