CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sarah Bush Lincoln Health Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $257
  • Cash Discount Price: $702
  • vs. Medicare Baseline: 0.28x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sarah Bush Lincoln Health Center is $257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $702. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.28x the Medicare baseline. Located in 1000 Health Center Drive P O Box 372, Mattoon, IL.
Cash / Self-Pay
$702

Average discount available for prompt cash payment at this facility.

Insurance Median
$257

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: $702 (76%)
Insurance Median: $257 (28%)
Cash: $702 (76% of Medicare)
Ins. Median: $257 (28% 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.

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
Plain Church Mg-All Plans $114 - $447 12%
Aetna $125 - $1,005 13%
Bc Comm Mmai $125 13%
Beacon Health Options Behav-All Plans $125 13%
Hlth Alliance Mcr Adv $125 13%
Humana $125 - $128 13%
Meridian Mcaid $125 13%
Meridian Mmai-All Other Plans $125 13%
Molina Mmai-All Other Plans $125 13%
Tricare $125 13%
UnitedHealthcare $125 - $927 13%
Va Ccn-All Plans $125 13%
Wellcare Med Adv-All Plans $125 13%
Bc Med Adv Ppo/Hmo $129 14%
Mennonite-All Plans $129 - $503 14%
First Health-All Plans $186 20%
Eiu Athlete-All Other Plans $200 - $782 22%
Healthscope-All Plans $212 - $827 23%
Rural King-All Plans $212 - $827 23%
Hope Trust-All Plans $229 - $894 25%
Multiplan-All Plans $232 25%
Eiu Student $235 - $916 25%
Allied National-All Plans $240 - $938 26%
Companion Life-All Plans $240 - $938 26%
Innovative Hlthware-All Plans $243 - $949 26%
Healthlink Hmo $246 - $961 27%
Healthlink Ppo - All Other Plans $246 - $961 27%
Cigna $257 - $1,005 28%
Consociate-All Plans $257 - $1,005 28%
Cphp-All Plans $257 - $1,005 28%
Beech Street-All Plans $263 - $1,028 28%
Hfn-All Plans $263 - $1,028 28%
Bc Comm Care Mcaid $344 37%
Hlth Alliance Mcaid $344 37%
Molina Mcaid $344 37%
Blue Cross Blue Shield $363 - $793 39%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 Health Center Drive P O Box 372, Mattoon, IL 61938
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals