Upper endoscopy with biopsy
Facility: Susan B Allen Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $554
- Cash Discount Price: $1,070
- vs. Medicare Baseline: 0.60x 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.
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 |
|---|---|---|
| UnitedHealthcare | $350 | 38% |
| Providrs Care | $757 | 82% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $1,070, which is lower than the facility's gross charge of $1,646. While the hospital offers a negotiated rate of $554 for UnitedHealthcare and Providrs Care members, patients with high-deductible plans might find paying the cash price of $1,070 more cost-effective if their insurance allowed amount exceeds this figure. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than cash prices; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the lowest possible rate.
This procedure's pricing is evaluated against the Medicare benchmark of $926.63, which serves as a scientifically validated baseline for the true cost of care. The facility's cash rate is approximately 15% higher than the Medicare amount, reflecting standard commercial pricing dynamics where rates often range between 120% and 150% of Medicare for fair pricing. If a patient receives an itemized bill that includes unexpected charges or broad category summaries, they should request a full line-by-line audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain such discrepancies. Disputing these errors in writing with the billing supervisor is the most effective way to reduce medical debt and avoid balance billing surprises, especially if the patient receives care from out-of-network providers at an in-network facility.