CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Shirley Ryan Abilitylab

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,586
Cash Discount Price: $2,758
vs. Medicare Baseline: 3.87x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Shirley Ryan Abilitylab is $3,586. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,758. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.87x the Medicare baseline. Located in 355 E Erie St, Chicago, IL.

Cash / Self-Pay

$2,758

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,586

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: $2,758 (298%)

Insurance Median: $3,586 (387%)

Cash: $2,758 (298% of Medicare)

Ins. Median: $3,586 (387% 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 387% of the Medicare baseline (a markup of 287%). 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
Uic Physician Group-Campuscare	$2,298	248%
Personalcare Insurance Of Il/Firsthealth Grp Corp/Coventryhealth And Life Insurance Co	$2,446 - $3,907	264%
State Of Illinois	$2,446	264%
Affordable Health Care Concepts	$2,763	298%
University Of Chicago Practice Plan	$2,988	322%
Health Care Services Corporation Dba Managed Care Network Preferred	$3,131	338%
Gallagher Benefit Administrators	$3,448	372%
Unicare Life And Health Insurance	$3,586	387%
Private Healthcare Systems	$3,678	397%
Resurrection Health Care Preferred	$3,678	397%
Uic Physician Group	$3,724	402%
Cofinity Aka Ppom	$3,907	422%
Health Payors Organization	$3,907	422%
Healthnetwork	$4,045	437%
Hfn	$4,137	446%

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 $2,758.
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 Shirley Ryan Abilitylab 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.