CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Washington County Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$197

about 0.2× the $927 Medicare rate · typically $122–$1,025

modeled estimate · not a bill or quote

What this hospital charges insurers

$130

Below the fair price — a good deal

about $67 under the fair price · 0.1× Medicare

Medicare pays $927 Fair price $197 This hospital $130 Cash price $2,372 Hospital's list price $2,965

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

One of the lower prices — 5 of 8 other IL hospitals charge more for the same procedure.

Cheapest $82 Priciest $151

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $197 (about 0.2× the $927 Medicare rate). Washington County Hospital charges insurers about $130, or about $2,372 in cash — below the fair price — a good deal. Located in Nashville, IL.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$130 - $339	14%
Blue Cross Blue Shieldmajor	$130 - $242	14%
Aetnamajor	$130 - $147	14%
Cignamajor	$175	19%
Humanamajor	$130	14%
Ambetter (Centene)	$130	14%
HealthLink	$162 - $169	17%
Medica	$130 - $162	14%
Meridian	$130 - $134	14%
Molina	$130 - $134	14%
WellCare	$130	14%

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 2,372), 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 Washington County Hospital 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 Washington County Hospital

Compare: Upper endoscopy with biopsy at other IL hospitals

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