Upper endoscopy with biopsy
Facility: Wichita County Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,048
- Cash Discount Price: $940
- vs. Medicare Baseline: 1.13x 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 |
|---|---|---|
| Medicaid / KanCare | $339 - $1,196 | 37% |
| UnitedHealthcare | $900 - $1,450 | 97% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy procedure at Wichita County Health Center in Leoti, Kansas, the facility's cash median price of $940.00 is lower than the Medicaid / KanCare negotiated rate of $339 to $1,196 and the UnitedHealthcare range of $900 to $1,450. This suggests that patients with high-deductible plans or those without insurance may save money by paying the cash price directly, as the cash rate is below the insurer's allowed amounts. However, because the facility is a Critical Access Hospital owned by the local government, patients should explicitly ask about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can further reduce the final cost.
When evaluating the financial value of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this code is $926.63, and the facility's cash price of $940.00 is slightly higher than this federal baseline, indicating a minimal markup relative to the true cost of care. While the negotiated rates for Medicaid and UnitedHealthcare exceed the Medicare amount, reflecting standard administrative and contract dynamics, patients should be aware that balance billing is generally prohibited for emergency services at in-network facilities under the No Surprises Act. If a patient receives a bill exceeding the allowed amount, they should request an itemized audit to identify any unbundled codes or services not rendered, ensuring they are not paying for unnecessary charges.