CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Rush Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $145
Cash Discount Price: $632
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Rush Memorial Hospital is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $632. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.16x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$632

Average discount available for prompt cash payment at this facility.

Insurance Median

$145

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: $632 (68%)

Insurance Median: $145 (16%)

Cash: $632 (68% of Medicare)

Ins. Median: $145 (16% 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
UnitedHealthcare	$101 - $116	11%
Caresource Mcr Adv	$116	13%
Aetna	$117 - $135	13%
Humana	$117 - $124	13%
Blue Cross Blue Shield	$120 - $366	13%
Today'S Option Mcr Adv-All Plans	$120	13%
Viant Beech St Mcr Adv	$120	13%
My True Advantage - All Plans	$122	13%
Consumers Life Ins-All Plans	$135	15%
Phcs-All Plans	$145	16%
Caresource Marketplace-All Other Plans	$157	17%
Cigna	$422	46%
Health Net	$422	46%
Multiplan-All Plans	$563	61%
Coventry/First Health-All Plans	$590	64%
Encore Health Services-All Plans	$613	66%
Siho-All Plans	$613	66%

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 $632.
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 Rush 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.