Upper endoscopy with biopsy
Facility: Community Memorial Healthcare, Inc.
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $462
- Cash Discount Price: $1,186
- vs. Medicare Baseline: 0.50x 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 |
|---|---|---|
| Aetna | $116 - $1,044 | 13% |
| UnitedHealthcare | $127 - $746 | 14% |
| Blue Cross Blue Shield | $323 - $1,153 | 35% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $1,186, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates charged by major payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield, where allowed amounts range from $116 to $1,153 depending on the specific plan. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find that paying the cash price upfront is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can further reduce the final bill.
The facility's pricing is benchmarked against Medicare, which sets a standard rate of $926.63 for this service. The cash price of $1,186 represents a markup relative to this federal baseline, illustrating how commercial rates can differ from government-set costs. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill that obscures individual charges. If a balance bill arises from an out-of-network service, the No Surprises Act may provide protection against unexpected costs, and patients should dispute any surprise charges in writing rather than paying immediately out of fear. Always verify your deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can result in higher out-of-pocket expenses than paying the cash price directly.