CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Carle Richland Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $822
Cash Discount Price: $2,741
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Carle Richland Memorial Hospital is $822. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,741. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.89x the Medicare baseline. Located in 800 East Locust Street, Olney, IL.

Cash / Self-Pay

$2,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$822

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: $2,741 (296%)

Insurance Median: $822 (89%)

Cash: $2,741 (296% of Medicare)

Ins. Median: $822 (89% 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
Cigna	$82	9%
Aetna	$576 - $2,286	62%
Blue Cross Blue Shield	$576 - $1,919	62%
Humana	$576	62%
Meridian	$576	62%
Molina	$576 - $822	62%
UnitedHealthcare	$576 - $2,094	62%
Wellcare	$576	62%
Healthlink	$1,782 - $1,919	192%
Multiplan/Phcs	$2,330 - $2,385	251%

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 $2,741.
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 Carle Richland 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.