CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Anthony Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$706

about 0.8× the $927 Medicare rate · typically $350–$1,010

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,021

Above the fair price

about $315 over the fair price · 1.1× Medicare

Medicare pays $927 Fair price $706 This hospital $1,021 Cash price $1,250 Hospital's list price $2,084

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 $1,021

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 $706 (about 0.8× the $927 Medicare rate). Saint Anthony Medical Center charges insurers about $1,021, or about $1,250 in cash — above the fair price. Located in Rockford, IL.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $706. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$4,157	449%
Blue Cross Blue Shieldmajor	$991	107%
Aetnamajor	$982	106%
Humanamajor	$372 - $4,831	40%
+ 4 smaller / regional plans	$972 - $4,932

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 1,250), 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 Anthony Medical Center 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 Anthony Medical Center

Compare: Upper endoscopy with biopsy at other IL hospitals

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