CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Fayette County Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $344
Cash Discount Price: $1,718
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Fayette County Hospital is $344. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,718. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.37x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$1,718

Average discount available for prompt cash payment at this facility.

Insurance Median

$344

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: $1,718 (185%)

Insurance Median: $344 (37%)

Cash: $1,718 (185% of Medicare)

Ins. Median: $344 (37% 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
Health Alliance Mcare	$125	13%
Healthlink Mcr Adv	$125	13%
Aetna	$134 - $344	14%
Cigna	$152	16%
Coventry/Ghp-All Plans	$176	19%
Multiplan - All Plans	$232	25%
Health Alliance - All Other Plans	$251	27%
Blue Cross Blue Shield	$344 - $767	37%
Illinicare - All Plans	$344	37%
Medicaid / KanCare	$344	37%
Meridian-All Plans	$344	37%
UnitedHealthcare	$1,426	154%
Healthlink Hmo	$1,477	159%
Healthlink Ppo - All Other Plans	$1,477	159%

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 $1,718.
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 Fayette County 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.