Upper endoscopy with biopsy
Facility: Ann & Robert H Lurie Childrens Hospital of Chicago
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,593
- Cash Discount Price: $2,269
- vs. Medicare Baseline: 2.80x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 280% of the Medicare baseline (a markup of 180%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $551 - $2,656 | 59% |
| Magellan | $900 - $2,593 | 97% |
| Mercycare Health | $1,199 | 129% |
| Cigna | $1,361 - $2,301 | 147% |
| Blue Cross Blue Shield | $1,403 - $2,593 | 151% |
| Aetna | $1,620 - $14,756 | 175% |
| Beacon Health Options | $1,620 | 175% |
| La Rabida Childrens Hospital | $1,620 | 175% |
| Centegra | $1,945 | 210% |
| Independent Physicians At Mercy | $1,945 | 210% |
| Advanced Physicians Association Ipa | $2,269 | 245% |
| Health Plus | $2,269 | 245% |
| Imagine Health | $2,269 | 245% |
| Methodist First Choice | $2,269 | 245% |
| Northwest Community Healthcare | $2,269 | 245% |
| Presence Health Partners | $2,269 | 245% |
| St. Francis | $2,269 | 245% |
| Ui Health | $2,269 | 245% |
| West Suburban Health Providers | $2,269 | 245% |
| Shriners Hospital | $2,431 | 262% |
| Swedish Covenant Physician Partners | $2,431 | 262% |
| American Psych Systems | $2,593 | 280% |
| Health Alliance | $2,593 | 280% |
| Macneal Health | $2,593 | 280% |
| Healthlink Inc. | $2,674 | 289% |
| Cofinity | $2,755 | 297% |
| Hfn Inc | $2,755 - $2,917 | 297% |
| Humana | $2,755 | 297% |
| Principal Healthcare | $2,755 | 297% |
| St. Elizabeth | $2,755 | 297% |
| First Health | $2,852 | 308% |
| Healthstar | $2,852 | 308% |
| Preferred Health Network | $2,852 | 308% |
| Sagamore Health Network | $2,852 | 308% |
| Beech Street | $2,917 | 315% |
| Benchmark Health | $2,917 | 315% |
| Employer'S Coalition On Health | $2,917 | 315% |
| Private Health Care System | $2,917 | 315% |
| Security Health Plan | $2,917 | 315% |
| Swedish American | $2,917 | 315% |
| Wellmark/Healthnetwork | $2,982 | 322% |
| Health Smart | $3,079 | 332% |
| Integrated Health Plan | $3,079 | 332% |
| Multiplan | $3,079 | 332% |
| National Provider Network | $3,079 | 332% |
| Wea Insurance Group | $3,079 | 332% |
| Unicare | $3,678 - $10,500 | 397% |
| UnitedHealthcare | $8,365 - $9,247 | 903% |