CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Deaconess Illinois Crossroads

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $406
Cash Discount Price: $376
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Deaconess Illinois Crossroads is $406. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $376. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.44x the Medicare baseline. Located in 8 Doctors Park Rd, Mount Vernon, IL.

Cash / Self-Pay

$376

Average discount available for prompt cash payment at this facility.

Insurance Median

$406

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: $376 (41%)

Insurance Median: $406 (44%)

Cash: $376 (41% of Medicare)

Ins. Median: $406 (44% 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	$130 - $997	14%
Blue Cross Blue Shield	$130 - $977	14%
Humana	$130 - $977	14%
Meridian Health Plan	$130 - $977	14%
Molina Healthcare Of Illinois	$130 - $987	14%
Mytru Advantage	$130 - $977	14%
Umwa	$130 - $977	14%
UnitedHealthcare	$130 - $977	14%
Wellcare	$130 - $977	14%
Healthlink	$162 - $169	17%
Alliance Coal	$179 - $1,613	19%
Alter-Net Medical Services, Inc.	$208 - $2,785	22%
Noncontracted	$208 - $1,564	22%
Deaconess Onecare	$266	29%
Self-Pay	$376	41%
Cigna	$418	45%
Prime Health Services	$806	87%
Guardian Resources, Inc.	$903	97%
Healthcare'S Finest Network (Hfn)	$914	99%
Medicalcontrol Network Solutions	$914	99%
National Provider Network	$914	99%
Three Rivers Provider Network	$935	101%
Beech Street	$946	102%
Care Improvement Plus	$997	108%
Hope Trust	$2,785	301%

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 $376.
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 Deaconess Illinois Crossroads 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.