CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hammond Henry Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $736
Cash Discount Price: $1,204
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hammond Henry Hospital is $736. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,204. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.79x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$1,204

Average discount available for prompt cash payment at this facility.

Insurance Median

$736

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: $1,204 (130%)

Insurance Median: $736 (79%)

Cash: $1,204 (130% of Medicare)

Ins. Median: $736 (79% 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
Cigna	$49 - $1,752	5%
Multiplan Phcs Adult	$90 - $1,204	10%
Multiplan Phcs Pediatric	$90 - $1,204	10%
Tricare	$113 - $217	12%
Aetna	$125 - $2,301	13%
Health Alliance Mcare Adv	$125 - $241	13%
Humana	$125 - $1,204	13%
UnitedHealthcare	$125 - $241	13%
Blue Cross Blue Shield	$140 - $2,301	15%
Health Alliance-All Other Plans	$163 - $1,004	18%
Ambetter / Centene	$188 - $937	20%
Quad City Community Hc-All Plans	$189 - $669	20%
Multiplan Pponext	$213 - $1,070	23%
Springfield Armory-All Plans	$245 - $870	26%
Multiplan-All Other Plans	$251 - $1,137	27%
Wellmark Of Ia-All Plans	$263 - $669	28%
Multiplan Integrated Hp	$1,004	108%
Osf Direct Access Network-All Plans	$1,070	115%
Corvel-All Plans	$1,204	130%
Healthsmart Adult-All Other Plans	$1,204	130%
Healthsmart Pediatric	$1,204	130%
Hfn-All Plans	$1,204	130%
Multiplan Beech Street	$1,204	130%
Usa Mco-All Plans	$1,204	130%
Meridian Health Plan-All Plans	$1,338 - $2,301	144%

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 $1,204.
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 Hammond Henry 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.