Upper endoscopy with biopsy
Facility: Centura St. Catherine-Dodge City
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $124
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.13x 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 |
|---|---|---|
| Cigna | $124 | 13% |
| Aetna | $124 | 13% |
| Medicare (plans) | $124 | 13% |
| Blue Cross Blue Shield | $124 | 13% |
| Kansas Health | $124 | 13% |
| Kaiser | $124 | 13% |
| Humana | $124 | 13% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Centura St. Catherine-Dodge City in Dodge City, KS, the negotiated rate for in-network insurance plans is $124.00, which matches the lowest and highest amounts reported across seven payers including Cigna, Aetna, and Medicare. This specific negotiated rate is significantly lower than the typical commercial markup seen in many facilities, where rates often average 200% to 300% of the Medicare benchmark of $926.63 for this procedure. While the facility is a Proprietary Acute Care Hospital, the consistency of the $124.00 rate across major payers suggests a transparent pricing structure that avoids the high variability often found in out-of-network scenarios, where balance billing could otherwise result in unexpected charges far exceeding the allowed amount.
Patients should be aware that while insurance contracts cap the billed amount at $124.00, the actual out-of-pocket cost depends on individual plan deductibles and copays. If a patient has a high-deductible plan, paying the cash price directly might be more cost-effective than the insurance negotiated rate if the insurer's allowed amount exceeds the cash price, though in this specific case, the data indicates a uniform negotiated rate. To minimize costs, patients are encouraged to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees. Additionally, since over 80% of hospital bills contain errors, patients should request a full itemized CPT-coded statement rather than accepting a summary bill, ensuring they