Upper endoscopy with biopsy
Facility: Smith County Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,665
- Cash Discount Price: $1,771
- vs. Medicare Baseline: 1.80x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,142 | 123% |
| Medicaid / KanCare | $1,240 - $1,771 | 134% |
| Multiplan-All Plans | $1,594 | 172% |
| Wppa-All Plans | $1,665 | 180% |
| Health Partners Of Ks Ppo-All Plans | $1,683 | 182% |
| UnitedHealthcare | $1,683 | 182% |
| Midlands Choice-All Plans | $1,683 | 182% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Smith County Memorial Hospital in Smith Center, KS, the cash price is $1,771, which matches the facility's median negotiated rate of $1,665. This cash price is significantly higher than the Medicare benchmark of $926.63, indicating a markup of 180% above the federal cost baseline. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more affordable than using insurance, as the negotiated rates for payers like Medicaid/KanCare range from $1,142 to $1,771 depending on the specific plan. It is important to note that while the facility offers a cash price, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can reduce the final cost by bypassing administrative fees and claims processing delays.
The data reflects a single CPT code with no variation across the seven payers listed, meaning the negotiated rates are fixed for each carrier rather than fluctuating by plan tier. For instance, Blue Cross Blue Shield has a single plan paying exactly $1,142, whereas Medicaid/KanCare has three plans with rates ranging from $1,240 to $1,771. Because the facility is in-network for these payers, the No Surprises Act protects patients from balance billing for emergency or non-emergency services, preventing unexpected bills for out-of-network ancillary services like lab work or emergency physicians. However, patients should still request a full itemized bill to ensure no unbundled charges or services