Upper endoscopy with biopsy
Facility: Wilson Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,567
- Cash Discount Price: $1,469
- vs. Medicare Baseline: 1.69x 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 |
|---|---|---|
| Tricare | $1,038 | 112% |
| Humana | $1,038 | 112% |
| Ambetter / Centene | $1,038 - $1,959 | 112% |
| UnitedHealthcare | $1,038 - $1,822 | 112% |
| Aetna | $1,038 - $1,959 | 112% |
| Blue Cross Blue Shield | $1,142 - $1,959 | 123% |
| Cigna | $1,567 | 169% |
| Mulitplan-All Plans | $1,802 | 194% |
| Health Partners-All Plans | $1,802 | 194% |
Consumer Guidance & Cost Commentary
For the CPT code 43239, "Upper endoscopy with biopsy," Wilson Medical Center in Neodesha, KS, lists a gross charge of $1,959. This amount is significantly higher than the Medicare benchmark of $926.63, which serves as the federal baseline for this procedure. While the facility offers a cash median price of $1,469, this rate remains above the Medicare amount, illustrating that commercial negotiated rates often exceed the true cost of care. Patients should be aware that in-network insurance plans typically pay negotiated rates that can range from $1,038 to $1,959 depending on the carrier, meaning that paying cash directly might result in lower out-of-pocket costs if the patient's insurance deductible has not yet been met.
To minimize expenses, consumers should verify whether the facility offers "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Since the facility is a Critical Access Hospital with government local ownership, it is advisable to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still confirm their specific plan details to avoid unexpected charges. Always compare the facility's allowed amounts against your insurance plan's allowed amounts to ensure you are not paying more than necessary.