Upper endoscopy with biopsy
Facility: Nmc Health
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $834
- Cash Discount Price: $1,595
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Bluestem Pace | $112 - $834 | 12% |
| Medicaid / KanCare | $180 - $1,334 | 19% |
| Leading Age | $180 - $1,334 | 19% |
| Wppa | $395 - $2,110 | 43% |
| Occunet | $431 - $2,302 | 47% |
| Medincrease Health Plan | $467 - $2,494 | 50% |
| Samaritan Ministries International | $467 - $2,494 | 50% |
| Prime Health Services | $539 - $2,878 | 58% |
| Aetna | $592 - $4,852 | 64% |
| UnitedHealthcare | $647 - $3,453 | 70% |
| Cigna | $683 - $3,645 | 74% |
| Blue Cross Blue Shield | $1,153 | 124% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Nmc Health in Newton, KS, the cash price of $1,595 is significantly lower than the facility's gross charge of $2,638. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $592 to $4,852, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans. The facility's cash rate is also notably higher than the state average for this procedure, which is approximately $1,100, suggesting that while the cash price is competitive relative to the facility's own list, it remains above the typical cost for this service in Kansas.
To ensure you are receiving the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills can obscure individual charges or unbundled codes that may not have been rendered. Additionally, patients should verify their deductible status and ask specifically about "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, effectively bypassing the administrative costs associated with insurance claims processing. Always confirm that your plan is in-network and review the specific allowed amounts for your carrier, as negotiated rates vary widely among the 12 payers listed for this service.