Upper endoscopy with biopsy
Facility: St. Catherine Hospital - Garden City
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $131
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.14x 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 |
|---|---|---|
| Kaiser | $122 - $131 | 13% |
| Medicare (plans) | $122 - $131 | 13% |
| Kansas Health | $122 | 13% |
| UnitedHealthcare | $122 - $131 | 13% |
| Humana | $122 - $131 | 13% |
| Aetna | $122 - $131 | 13% |
| Blue Cross Blue Shield | $122 - $1,367 | 13% |
| Cigna | $122 - $131 | 13% |
| Devoted Health | $131 | 14% |
| Innovage | $131 | 14% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at St. Catherine Hospital in Garden City, KS, the negotiated rates range from $122 to $1367 across ten payers, with a median negotiated rate of $131.00. This facility is a voluntary non-profit church-owned acute care hospital. While specific cash and median paid amounts are not available in this dataset, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. It is crucial to 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 data indicates a significant variance in pricing depending on the payer, with Blue Cross Blue Shield showing a high-end range up to $1,367 compared to a low-end of $122, while most other payers cluster between $122 and $131. Although state or county average comparisons are not provided in this specific record, understanding that commercial negotiated rates often include administrative overhead can help patients evaluate if a rate is reasonable. If you receive a bill that appears to include charges for services not rendered or items that were bundled into a single code, you have the right to request a detailed itemized audit to identify errors. Furthermore, if you are an out-of-network patient receiving care at this in-network facility, you may be protected from balance billing for emergency services or non-emergency services at in-network hospitals under the No Surprises Act, so it is advisable to dispute any