Upper endoscopy with biopsy
Facility: Bob Wilson Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,540
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.66x 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 | $1,540 | 166% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Bob Wilson Memorial Hospital in Ulysses, KS, the negotiated rate with Blue Cross Blue Shield is $1,540. This amount is significantly higher than the Medicare benchmark of $926.63, reflecting a markup of 1.7 times the federal rate. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and claim processing fees, patients with high-deductible plans may find that paying the cash price directly is more economical. Since the cash median and negotiated median are both null in the provided data, it is important to contact the hospital directly to confirm if a self-pay or prompt-pay discount is available, as these upfront incentives can bypass the standard insurance billing cycle and reduce overall costs.
This facility operates as a Critical Access Hospital with voluntary non-profit, church ownership, and serves the 67880 zip code. Because the data does not include state or county average comparisons for this specific service, patients should be aware that negotiated rates vary widely even within the same network; assuming that being in-network guarantees the lowest price is a common pitfall. If you receive a bill for this service, you should request a full itemized audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Furthermore, if you are an out-of-network patient receiving care at this in-network facility, the No Surprises Act may protect you from balance billing for emergency or non-emergency services, so you should never sign away your rights to dispute surprise charges without first reviewing the specific terms of your plan.