Upper endoscopy with biopsy
Facility: Neosho Memorial Regional Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $366
- Cash Discount Price: $289
- 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 |
|---|---|---|
| Tricare | $119 | 13% |
| Medicaid / KanCare | $294 | 32% |
| Wppa_Providrscare | $319 | 34% |
| United | $320 | 35% |
| Hpk | $366 | 39% |
| Coventry | $366 | 39% |
| Cigna | $366 | 39% |
| Blue Cross Blue Shield | $385 - $428 | 42% |
| Ambetter / Centene | $385 | 42% |
| Aetna | $385 | 42% |
| Medicare (plans) | $428 | 46% |
| Humana | $428 | 46% |
| Medadv_Allwell | $428 | 46% |
| Va_Ccn | $428 | 46% |
| Medadv_Uhc | $428 | 46% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Neosho Memorial Regional Medical Center in Chanute, KS, the billed amount varies significantly depending on your insurance plan, ranging from a low of $119 for Tricare to a high of $428 for several major carriers like Medicare and Humana. While the facility's cash price is $289, which is lower than the median negotiated rate of $366, patients with high-deductible plans may find that paying cash upfront is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. It is important to note that this facility is a Critical Access Hospital with government local ownership, and while the facility rating is 1, the specific pricing for this procedure reflects the unique contract dynamics of the region rather than a statewide average, as no county or state average was provided in the data.
Commercial insurance contracts create a ceiling on what providers can charge, but these negotiated rates often include administrative costs that inflate the baseline price by 20% to 40% compared to direct cash payments. For example, while the Medicare benchmark for this service is $926.63, the facility's cash rate of $289 demonstrates a pricing structure that is substantially lower than the federal baseline, suggesting that the commercial negotiated rates of $385 to $428 seen by many payers are marked up relative to the true cost of care. To minimize out-of-pocket expenses, patients should verify their specific plan's allowed amount before scheduling and explicitly request self-pay or prompt-pay discounts, which can reduce bills by 20% to 50% if paid in full upfront, bypassing the complex claims processing