Upper endoscopy with biopsy
Facility: Amberwell Atchison Association
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $158
- Cash Discount Price: $631
- vs. Medicare Baseline: 0.17x 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 |
|---|---|---|
| Humana | $116 - $155 | 13% |
| Superior Select Mcr Adv - All Plans | $116 | 13% |
| Va Ccn - All Plans | $116 | 13% |
| UnitedHealthcare | $116 - $225 | 13% |
| Triwest - All Plans | $116 | 13% |
| Centrus Health Direct - All Plans | $139 | 15% |
| Cigna | $152 | 16% |
| Ambetter / Centene | $180 | 19% |
| Oscar - All Plans | $185 | 20% |
| Multiplan - All Plans | $220 | 24% |
| Aetna | $451 | 49% |
| Wppa Providrs Care - All Plans | $493 | 53% |
| Blue Cross Blue Shield | $585 | 63% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Amberwell Atchison Association, the cash price is $631.00, which matches the facility's cash median. This amount is significantly lower than the Medicare benchmark of $926.63, indicating a markup of 0.2 above the federal baseline. While the facility is a Critical Access Hospital in Atchison, KS, with 13 different payers, the negotiated rates vary widely, ranging from $116 to $585 depending on the insurance plan. For instance, Humana and Superior Select Mcr Adv have a low-end rate of $116, whereas Blue Cross Blue Shield's rate is $585. Patients with high-deductible plans may find the cash price of $631.00 more affordable than their insurance's negotiated rate if the allowed amount exceeds the cash price, making it worthwhile to ask the hospital about self-pay or prompt-pay discounts before scheduling.
The facility's negotiated rate of $158.00 represents the average amount paid by insurance carriers for this service, though individual plans like Aetna and Wppa Providrs Care pay significantly higher amounts of $451 and $493 respectively. It is important to note that commercial negotiated rates often include administrative costs for claims processing, which can inflate the baseline price by 20% to 40% compared to direct cash payments. To ensure you are not overcharged, you should request an itemized billing audit to verify that all charges are accurate and that no services were unbundled or double-billed. Additionally, if you are concerned about balance billing, remember that the No