CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Anderson Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,016
Cash Discount Price: $588
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Anderson Hospital is $1,016. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $588. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.10x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$588

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,016

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: $588 (63%)

Insurance Median: $1,016 (110%)

Cash: $588 (63% of Medicare)

Ins. Median: $1,016 (110% 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
Medicaid / KanCare	$287 - $1,210	31%
Tricare	$339 - $5,792	37%
Humana	$395 - $4,876	43%
Medicare (plans)	$395 - $4,876	43%
UnitedHealthcare	$395 - $4,876	43%
Health Care Service Corporation	$538 - $565	58%
Self Pay	$588 - $25,000	63%
Work Comp	$609 - $1,953	66%
Blue Cross Blue Shield	$654 - $1,300	71%
Cigna	$824	89%
Healthlink	$824 - $883	89%
Multiplan/Phcs	$883	95%
Aetna	$956 - $4,876	103%
Essence	$972 - $5,121	105%
Devoted Health Ppo	$976 - $4,973	105%
Clear Springs Health	$985 - $5,022	106%
Mercy Benefit Admin	$1,030	111%
Beech Street Corporation	$1,059	114%
Mercy Aco	$1,200	130%
Ambetter / Centene	$1,409 - $7,209	152%
Blue Choice	$1,409 - $7,209	152%
Hopetrust	$2,430 - $12,429	262%

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 $588.
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 Anderson 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.