Upper endoscopy with biopsy
Facility: Pratt Regional Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,056
- Cash Discount Price: $883
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Christian Health Aid | $758 - $1,295 | 82% |
| Celtic Insurance Company | $840 | 91% |
| UnitedHealthcare | $841 - $1,761 | 91% |
| Health Partners Of Kansas | $859 - $1,467 | 93% |
| Healthy Blue | $865 | 93% |
| Aetna | $910 - $1,553 | 98% |
| Choicecare | $1,011 - $1,726 | 109% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Pratt Regional Medical Center in Pratt, KS, the cash price of $883.00 is notably lower than the facility's gross charge of $1,262.00. While the facility's negotiated rates range from $840 to $1,761 depending on the insurance carrier, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance negotiated rate exceeds the cash price. It is important to note that the cash rate of $883.00 is significantly below the Medicare benchmark of $926.63, which serves as the objective baseline for evaluating hospital pricing markups. Commercial rates often average 200% to 300% of Medicare, but this specific cash rate suggests a favorable position relative to the federal standard.
Before scheduling, patients should verify their specific insurance plan's negotiated rate, as these vary widely among the seven payers listed, with UnitedHealthcare showing a high of $1,761 and Celtic Insurance Company a fixed rate of $840. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request a self-pay or prompt-pay discount before check-in to avoid automatic claims submission that could void cash savings. Given that over 80% of hospital bills contain errors, patients should always request a full itemized CPT-coded bill rather than accepting a summary invoice, ensuring they can identify any unbundled codes or services not rendered.