Upper endoscopy with biopsy
Facility: Regional Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $870
- Cash Discount Price: $511
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 94% |
Consumer Guidance & Cost Commentary
For an Upper endoscopy with biopsy at Regional Medical Center in Manchester, IA, the cash median price is $511, which is significantly lower than the facility's gross charge of $639 and the Medicare benchmark of $926.63. While the median negotiated rate for Medical Associates Health Plan - Tri is set at $870, patients with high-deductible plans may find the cash price more favorable if their insurance allowed amount exceeds $511, as paying out-of-pocket avoids the administrative markup often embedded in commercial contracts.
The facility, a Critical Access Hospital owned by the government, maintains a rating of 4 stars and operates under a single payer agreement where both the high and low negotiated rates are identical at $870. To maximize savings, consumers should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment options can reduce the final cost by bypassing the insurance claims cycle. It is also advisable to request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.