Upper endoscopy with biopsy
Facility: Hospital District #6 Patterson Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $366
- Cash Discount Price: $488
- vs. Medicare Baseline: 0.39x 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 |
|---|---|---|
| UnitedHealthcare | $123 - $610 | 13% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Hospital District #6 Patterson Health Center in Anthony, KS, the cash price of $488.00 is lower than the UnitedHealthcare negotiated rate of $366.00, which is the maximum amount the insurer will pay for this service. While the facility is a Critical Access Hospital with government ownership, patients with high-deductible plans or those without insurance may find paying cash directly more cost-effective than relying on insurance, as the cash price avoids the administrative markup often found in commercial contracts. It is important to note that while the cash rate is lower than the insurer's allowed amount, patients should verify their specific plan details, as some policies may cover the full negotiated rate even if it exceeds the cash price.
The Medicare benchmark for this procedure is $926.63, which serves as a reliable baseline for evaluating the facility's pricing structure. Although the data does not provide specific state or county average comparisons for this exact code, the Medicare rate indicates that the cash price of $488.00 represents a significant portion of the federal cost basis, suggesting a transparent and competitive rate for self-pay patients. To ensure you receive the best possible price, we recommend requesting a prompt-pay discount from the billing department before scheduling, as paying in full upfront can often reduce the final amount further. Additionally, if you have any questions about your specific insurance coverage or potential balance billing scenarios, please contact the hospital directly to confirm your out-of-pocket costs prior to receiving care.