Upper endoscopy with biopsy
Facility: Medicine Lodge Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,432
- Cash Discount Price: $1,507
- vs. Medicare Baseline: 1.55x 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 |
|---|---|---|
| Tricare | $102 - $1,281 | 11% |
| Humana | $110 - $1,456 | 12% |
| Aetna | $133 - $1,600 | 14% |
| Medicaid / KanCare | $285 - $1,600 | 31% |
| Hpk-All Plans | $598 - $1,520 | 65% |
| UnitedHealthcare | $1,432 - $1,520 | 155% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $1,507.00, which matches the cash median for this service. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. In this case, the median negotiated rate across payers is $1,432.00, and the highest allowed amount is $1,600.00, meaning paying out-of-pocket could result in lower total costs for individuals with high-deductible plans or those who have already met their insurance thresholds.
The facility's pricing is significantly higher than the Medicare benchmark, which stands at $926.63 for this code, indicating a markup typical of commercial billing practices. However, patients should avoid paying balance bills immediately if they receive care from out-of-network providers, as the No Surprises Act protects against surprise billing for emergency and non-emergency services at in-network facilities. To ensure accuracy, consumers should request a full itemized CPT-coded bill before paying, as summary invoices often obscure unbundled charges or services not rendered. Additionally, patients are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if settled upfront, bypassing the costly insurance claims cycle.