Upper endoscopy with biopsy
Facility: Meade District Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,514
- Cash Discount Price: $1,750
- vs. Medicare Baseline: 1.63x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,514 | 163% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Meade District Hospital in Meade, Kansas, the cash price is $1,750.00, which matches the facility's median negotiated rate of $1,514.00 for Blue Cross Blue Shield. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data indicates no specific county or state average was provided for comparison. It is important to note that for patients with high-deductible plans, paying the cash price of $1,750.00 upfront may be more cost-effective than using insurance, as the negotiated rate of $1,514.00 is still subject to your deductible and coinsurance, and the administrative costs of claims processing often inflate the final bill. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the total cost by bypassing the standard insurance billing cycle.
This service is benchmarked against Medicare, which covers $926.63 for this procedure. The commercial cash price of $1,750.00 represents a 1.6x markup compared to the Medicare amount, which is a common pricing structure for commercial rates. If you receive a bill from an out-of-network provider or for services like emergency care or lab tests at this facility, you may be subject to balance billing, where the provider charges the difference between their full rate and what your insurance pays. However, the No Surprises Act protects patients from these surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy, always request a full itemized bill before paying,