CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Loyola University Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,432
Cash Discount Price: $790
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Loyola University Medical Center is $1,432. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $790. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.55x the Medicare baseline. Located in 2160 S 1St Avenue, Maywood, IL.

Cash / Self-Pay

$790

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,432

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: $790 (85%)

Insurance Median: $1,432 (155%)

Cash: $790 (85% of Medicare)

Ins. Median: $1,432 (155% 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
Humana	$512 - $1,000	55%
Blue Cross Blue Shield	$909 - $3,619	98%
Aetna	$977 - $2,455	105%
Cigna	$1,007 - $2,115	109%
Molina	$1,026 - $1,432	111%
Wellcare	$1,026	111%
Oscar Ifp	$1,075	116%
Meridian	$1,114 - $1,432	120%
Molina Marketplace Ifp	$1,437	155%
UnitedHealthcare	$1,717 - $5,161	185%

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 $790.
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 Loyola University Medical Center 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.