Upper endoscopy with biopsy
Facility: Labette Health
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $640
- Cash Discount Price: $512
- vs. Medicare Baseline: 0.69x 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 |
|---|---|---|
| Aetna | $118 | 13% |
| Kansas Superior Select | $128 - $893 | 14% |
| Montgomery County | $132 - $1,587 | 14% |
| Uhccp | $234 | 25% |
| Medicaid / KanCare | $329 - $867 | 36% |
| Multiplan | $621 | 67% |
| Choicecare (First Health Network) | $658 | 71% |
| Health Partners Of Kansas, Inc | $658 | 71% |
| Ambetter / Centene | $731 | 79% |
| UnitedHealthcare | $867 | 94% |
| Blue Cross Blue Shield | $867 - $1,153 | 94% |
| Humana | $867 | 94% |
| Wellcare | $867 | 94% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Labette Health in Parsons, KS, the facility's cash price of $512.00 is lower than the gross charge of $731.00 but higher than the median negotiated rate of $640.00 reported for this service. While the cash price is attractive for patients without insurance, it is important to note that many commercial payers, such as Kansas Superior Select and Montgomery County, negotiate rates that can exceed the cash price due to administrative costs and contract structures. For instance, the high end of the range for Montgomery County plans reaches $1,587, which is significantly higher than the cash option. Patients with high-deductible plans or those who have already met their deductible may find paying the cash price of $512.00 directly to the hospital results in immediate savings compared to the potential out-of-pocket costs associated with insurance claims that include deductibles, copays, and coinsurance.
To ensure you are not overcharged, it is recommended to request a full itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill for the difference between the provider's chargemaster rate and your insurance allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, since this facility is an Acute Care Hospital with a government-local ownership structure, you should explicitly ask about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if settled upfront. Always verify your specific plan's