Upper endoscopy with biopsy
Facility: Wamego Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $236
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.25x 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 |
|---|---|---|
| UnitedHealthcare | $225 | 24% |
| Medicaid / KanCare | $234 - $236 | 25% |
| Aetna | $234 | 25% |
| Providrs Care | $478 | 52% |
| Tricare | $623 | 67% |
| Blue Cross Blue Shield | $1,515 - $1,595 | 163% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Wamego Health Center in Wamego, KS, the facility's negotiated rates range from $225 to $623 depending on the insurance plan, with a median negotiated amount of $236.00. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure. While the data does not provide specific cash or state/county average figures for direct comparison, it is important to note that cash-pay options can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price. Patients should always verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can significantly reduce out-of-pocket costs by bypassing administrative fees and claims processing delays.
The Medicare benchmark for this service is $926.63, which serves as a standardized baseline for evaluating pricing fairness. Although the data indicates a 0.3 variance versus Medicare, the primary focus for consumers should be understanding that commercial negotiated rates are often higher than cash prices due to multi-layered administrative structures. If a patient receives care from an out-of-network provider, they may face balance billing for the difference between the provider's full chargemaster rate and the insurance allowed amount, though the No Surprises Act protects against this for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, patients should request a full itemized CPT-coded bill before paying, as summary bills can obscure individual charges, and should formally dispute any errors in writing rather than accepting verbal assurances.