CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lafayette Regional Health Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$484

about 0.5× the $927 Medicare rate · typically $215–$2,080

modeled estimate · not a bill or quote

What this hospital charges insurers

$314

Below the fair price — a good deal

about $170 under the fair price · 0.3× Medicare

Medicare pays $927 Fair price $484 This hospital $314

How we calculate the fair BaseRate →

How this hospital compares to other MO hospitals

Highest price of the 9 MO hospitals we have prices for — worth calling around.

Cheapest $118 Priciest $314

Black dot = this hospital, among the 9 MO hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $484 (about 0.5× the $927 Medicare rate). Lafayette Regional Health Center charges insurers about $314 — below the fair price — a good deal. Located in Lexington, MO.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

2 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Aetna Blue Cross Blue ShieldCignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$294 - $3,041	32%
Aetnamajor	$305	33%
Amerigroup	$305	33%
UniCare	$305	33%
+ 4 smaller / regional plans	$300 - $2,550

Government programs also on file: Medicaid.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Lafayette Regional Health Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Lafayette Regional Health Center

Compare: Upper endoscopy with biopsy at other MO hospitals

Insurance negotiated median for the same procedure, sorted lowest first.