Upper endoscopy with biopsy
Facility: Ellinwood District Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $705
- Cash Discount Price: $856
- vs. Medicare Baseline: 0.76x 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 |
|---|---|---|
| Aetna | $385 - $1,026 | 42% |
| Cigna | $385 - $1,026 | 42% |
| Humana | $385 - $1,026 | 42% |
| Blue Cross Blue Shield | $385 - $1,026 | 42% |
| UnitedHealthcare | $385 - $1,026 | 42% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Ellinwood District Hospital in Ellinwood, KS, the cash price is $856.00, which is lower than the facility's negotiated rates of $705.00 paid by major insurers like Aetna, Cigna, and Humana. This data highlights a common billing dynamic where commercial insurance contracts often result in higher costs for patients than direct cash payment, particularly for those with high-deductible plans. Since the cash price is already below the median negotiated amount, patients with active insurance coverage may find themselves paying more out-of-pocket than expected if they do not verify their specific plan's allowed amount before scheduling.
When evaluating this cost against the broader healthcare landscape, it is important to compare rates to the Medicare benchmark of $926.63 rather than the facility's full chargemaster list price. The facility's cash rate of $856.00 represents a significant discount relative to the Medicare amount, suggesting a fair pricing structure that aligns closer to the "true cost" of care. Consumers should be aware that while balance billing is generally prohibited for emergency services at in-network facilities under the No Surprises Act, patients should still request a detailed, itemized bill to ensure no unbundled charges or services not rendered are included. Additionally, patients should explicitly ask about prompt-pay discounts or self-pay rates prior to check-in to secure the most favorable financial terms available.