CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hammond Henry Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$286

about 0.3× the $927 Medicare rate · typically $208–$892

modeled estimate · not a bill or quote

What this hospital charges insurers

$213

Below the fair price — a good deal

about $73 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $286 This hospital $213 Cash price $1,204 Hospital's list price $1,338

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $82 Priciest $213

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 $286 (about 0.3× the $927 Medicare rate). Hammond Henry Hospital charges insurers about $213, or about $1,204 in cash — below the fair price — a good deal. Located in Geneseo, 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	$125 - $241	13%
Blue Cross Blue Shieldmajor	$140 - $2,301	15%
Aetnamajor	$125 - $2,301	13%
Cignamajor	$49 - $1,752	5%
Humanamajor	$125 - $1,204	13%
Ambetter (Centene)	$188 - $937	20%
Meridian	$1,338 - $2,301	144%
+ 6 smaller / regional plans	$125 - $1,204

Government programs also on file: Military & VA.

Excludes 10 rental-network / third-party entries (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 1,204), 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 Hammond Henry 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 (%)

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Other Procedures at Hammond Henry Hospital

Compare: Upper endoscopy with biopsy at other IL hospitals

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