CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Memorial Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,140
Cash Discount Price: $1,900
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Memorial Medical Center is $1,140. 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 1.23x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$1,900

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,140

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: $1,140 (123%)

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

Ins. Median: $1,140 (123% 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
Blue Cross Blue Shield	$389 - $1,900	42%
Health Alliance	$608 - $3,421	66%
Veterans Administration	$689	74%
Current Health Network Ppo	$855	92%
Aetna	$870 - $1,444	94%
Medicare (plans)	$956 - $1,900	103%
Tricare	$956	103%
UnitedHealthcare	$956 - $7,724	103%
Cigna	$998	108%
Humana	$1,004 - $1,140	108%
Phcs/Multiplan	$1,026 - $1,140	111%
Healthlink	$1,083 - $2,400	117%
6 Degrees Health	$1,140	123%
Hopetrust	$1,140	123%
Hst	$1,140	123%
Magellan	$1,140	123%
Medicaid / KanCare	$1,210	131%
Consociate	$1,235	133%
Hfn	$1,235	133%
Molina	$1,235	133%
Preferred Plan	$1,425	154%
Soi Mcfarland	$1,425	154%
Soi Rushville	$1,425	154%
Corvel	$1,520	164%
Methodist First Choice	$1,520	164%
Mutual Medical Plans	$1,615	174%
Commercial Workers Compensation	$1,722	186%
Illinois Workers Compensation	$1,813	196%
Liability	$1,900	205%

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 Memorial 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.