CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Decatur Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,106
Cash Discount Price: $1,900
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Decatur Memorial Hospital is $1,106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,900. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.19x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$1,900

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,106

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: $1,900 (205%)

Insurance Median: $1,106 (119%)

Cash: $1,900 (205% of Medicare)

Ins. Median: $1,106 (119% 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
Aetna	$389 - $1,275	42%
Blue Cross Blue Shield	$389 - $1,900	42%
Coventry	$389 - $1,521	42%
Health Alliance	$389 - $1,264	42%
Humana	$389 - $1,482	42%
Medicare (plans)	$389 - $956	42%
UnitedHealthcare	$389 - $1,900	42%
Veterans Administration	$389 - $956	42%
Tricare	$395 - $972	43%
Illinois Workers Compensation	$799 - $1,807	86%
Mennonite Churches	$817	88%
Plain Church Medical Group	$855	92%
Health Alliance Mh Employee Plan	$874	94%
Cigna	$885	96%
Wellcare	$956	103%
Phcs Savility	$1,009	109%
Consociate	$1,121 - $1,406	121%
6 Degrees Health	$1,140	123%
Hopetrust	$1,140	123%
Hst	$1,140	123%
Medicaid / KanCare	$1,210 - $1,235	131%
Healthlink	$1,269 - $1,303	137%
Phcs Multiplan Ppo	$1,292	139%
Corvel	$1,368	148%
Hfn	$1,425 - $1,698	154%
Commercial Workers Compensation	$1,717	185%
Liability	$1,900	205%
Caterpillar	$2,187	236%

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 $1,900.
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 Decatur Memorial 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.