Upper endoscopy with biopsy
Facility: Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $121
- Cash Discount Price: $686
- vs. Medicare Baseline: 0.13x 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 | 13% |
| Ambetter / Centene | $127 | 14% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Memorial Hospital in Abilene, KS, the cash price is $686.00, which matches the facility's cash median. This rate is significantly lower than the Medicare benchmark of $926.63, indicating a markup of only 10% above the federal government's cost-based standard. While the facility's negotiated rates with Tricare ($116) and Ambetter/Centene ($127) are much lower than the cash price, patients with high-deductible plans should consider paying cash directly. In this scenario, the cash rate of $686.00 is cheaper than the insurance negotiated rates, meaning the patient would likely pay less out-of-pocket if they pay upfront rather than relying on insurance to cover the difference after their deductible is met.
Patients should be aware that hospitals often offer "prompt-pay" discounts for self-pay balances, which can further reduce the final cost. Since the facility is a Critical Access Hospital owned by a Government Hospital District, it is advisable to contact the billing department before scheduling to confirm self-pay or prompt-pay rates. Additionally, if you receive a bill from this facility, always request a full itemized statement rather than accepting a summary bill. This allows you to verify that no unbundled codes or services not rendered have been charged, ensuring you are only paying for the actual care provided.