Upper endoscopy with biopsy
Facility: Rawlins County Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,153
- Cash Discount Price: $1,442
- vs. Medicare Baseline: 1.24x 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 | $946 - $2,005 | 102% |
| Blue Cross Blue Shield | $1,153 | 124% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Rawlins County Health Center in Atwood, KS, the cash median price is $1,442.00, which is notably higher than the state average for this procedure. While the facility's negotiated rate with UnitedHealthcare is $1,153.00, patients with high-deductible plans may find the cash price more advantageous if the insurance allowed amount exceeds $1,442.00, as the cash rate avoids potential administrative markups. It is important to verify your specific plan's deductible status before scheduling, as paying the negotiated rate without meeting your deductible could result in out-of-pocket costs that exceed the cash option. Additionally, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.
The Medicare benchmark for this service is $926.63, serving as a scientifically validated baseline for the true cost of care. The facility's gross charge of $1,696.00 represents a significant markup compared to this federal standard, illustrating why comparing rates to the chargemaster list is misleading; commercial rates often average 200% to 300% of Medicare, whereas fair pricing typically aligns closer to 120% to 150%. If you receive a bill from this facility, request a detailed, itemized statement to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies. Under the No Surprises