CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Northwestern Medicine Kishwaukee Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,098
Cash Discount Price: $7,199
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Northwestern Medicine Kishwaukee Hospital is $3,098. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,199. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.34x the Medicare baseline. Located in One Kish Hospital Drive, Dekalb, IL.

Cash / Self-Pay

$7,199

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,098

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: $7,199 (777%)

Insurance Median: $3,098 (334%)

Cash: $7,199 (777% of Medicare)

Ins. Median: $3,098 (334% 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 334% of the Medicare baseline (a markup of 234%). 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	$841 - $3,953	91%
Health'S Finest Network [126]	$2,069 - $4,229	223%
UnitedHealthcare	$2,308 - $4,597	249%
Cigna	$2,423 - $2,441	261%
Blue Cross Blue Shield	$2,570 - $4,597	277%
The Alliance [1703]	$2,988	322%
Healthlink [125]	$3,448	372%
Choicecare [177]	$3,475	375%
Multiplan/Phcs [142]	$3,586 - $4,597	387%
Coventry [1218]	$3,953	427%
Coventryone Ppo [17110]	$3,953	427%
First Health Plan [6034]	$3,953	427%

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 $7,199.
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 Kishwaukee 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.