Upper endoscopy with biopsy
Facility: Trego County Lemke Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $969
- Cash Discount Price: $1,165
- vs. Medicare Baseline: 1.05x 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 | $116 - $827 | 13% |
| Medicaid / KanCare | $116 - $1,562 | 13% |
| Va Ccn - All Plans | $116 - $969 | 13% |
| UnitedHealthcare | $116 - $1,562 | 13% |
| Aetna | $116 - $1,406 | 13% |
| Ambetter / Centene | $121 - $1,066 | 13% |
| Healthy Blue Mcaid - All Plans | $285 - $1,562 | 31% |
| Humana | $672 - $766 | 73% |
| Health Partners - All Plans | $1,302 - $1,484 | 141% |
| Blue Cross Blue Shield | $1,577 | 170% |
Consumer Guidance & Cost Commentary
For the CPT code 43239, Upper endoscopy with biopsy, Trego County Lemke Memorial Hospital in Wakeeney, KS, has a cash median price of $1,165.00 and a median negotiated rate of $969.00. This facility is a Critical Access Hospital with government-local ownership. While the cash price is slightly lower than the median negotiated rate, patients with high-deductible plans should consider paying cash directly, as the insurance negotiated rate of $969.00 may exceed the cash price depending on the specific plan. It is important to verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront payment incentives can further reduce the total cost.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $926.63 for this procedure. The cash median of $1,165.00 represents a markup relative to this federal baseline, while the negotiated rate of $969.00 falls within the typical range of 100% to 105% of the Medicare amount. Commercial payers show a wide range of allowed amounts, with Tricare, Medicaid/KanCare, and Va Ccn ranging from $116 to $969, and UnitedHealthcare and Aetna ranging up to $1,562 and $1,406 respectively. Consumers should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.