CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Rush University Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,598
Cash Discount Price: $2,375
vs. Medicare Baseline: 2.80x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Rush University Medical Center is $2,598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,375. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.80x the Medicare baseline. Located in 1653 West Congress Parkway, Chicago, IL.

Cash / Self-Pay

$2,375

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,598

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: $2,375 (256%)

Insurance Median: $2,598 (280%)

Cash: $2,375 (256% of Medicare)

Ins. Median: $2,598 (280% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 280% of the Medicare baseline (a markup of 180%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$1,001 - $4,749	108%
Molina Fide-Snp	$1,011	109%
Meridian Dnsp	$1,021	110%
Cigna	$1,168 - $4,749	126%
Blue Cross Blue Shield	$1,210 - $4,749	131%
County Care Mcaid - All Plans	$1,210	131%
Meridian Mcaid - All Other Plans	$1,210	131%
Molina Mcaid	$1,283	138%
Ambetter / Centene	$1,312	142%
Molina Exch - All Other Plans	$1,322	143%
UnitedHealthcare	$2,688 - $6,411	290%
Devoted Mcr Adv - All Plans	$4,749	513%
Humana	$4,749	513%
Wellcare Mcr Adv - All Plans	$4,749	513%
Zing Hlth Mcr Adv - All Plans	$5,034	543%

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 $2,375.
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 Rush University Medical Center 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.