Upper endoscopy with biopsy
Facility: Mcpherson Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $834
- Cash Discount Price: $664
- 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 |
|---|---|---|
| Wppa - All Plans | $628 | 68% |
| Medical Associates - All Plans | $673 | 73% |
| Central Plains - All Plans | $673 | 73% |
| UnitedHealthcare | $700 - $897 | 76% |
| Christian Health Aid - All Plans | $718 | 77% |
| Tricare | $734 | 79% |
| Aetna | $740 - $897 | 80% |
| Multiplan - All Plans | $807 | 87% |
| Humana | $834 | 90% |
| Healthy Blue Mcr Adv | $834 | 90% |
| Blue Cross Blue Shield | $834 | 90% |
| Va Ccn - All Plans | $834 | 90% |
| Wellcare Mcr Adv - All Plans | $834 | 90% |
| Health Partners - All Plans | $852 | 92% |
| Cigna | $852 | 92% |
| First Health - All Plans | $852 | 92% |
| Medicaid / KanCare | $897 | 97% |
| Health Blue Mcaid - All Other Plans | $915 | 99% |
| Ambetter / Centene | $959 | 103% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Mcpherson Hospital in Mcpherson, KS, the cash price is $664.00, which is lower than the facility's gross charge of $897.00. While the hospital's negotiated rates with major payers like UnitedHealthcare and Aetna range from $700 to $897, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking prompt-pay discounts before receiving care. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about self-pay or prompt-pay discounts to ensure they are not left with unexpected bills.
The facility's cash rate of $664.00 is notably lower than the median negotiated rate of $834.00 and the Medicare benchmark of $926.63, suggesting that commercial insurance contracts may carry a higher administrative markup than direct payment. Although the data does not provide specific county or state average comparisons for this CPT code, the significant difference between the cash price and the Medicare rate highlights the importance of understanding the true cost baseline. Patients should request an itemized billing audit before finalizing payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.