Upper endoscopy with biopsy
Facility: Cheyenne County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,219
- Cash Discount Price: $873
- vs. Medicare Baseline: 1.32x 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 |
|---|---|---|
| First Health - All Plans | $143 - $1,296 | 15% |
| Firstguard - All Plans | $163 - $1,481 | 18% |
| Wppa - All Plans | $184 - $1,666 | 20% |
| Cpm - All Plans | $194 - $1,759 | 21% |
| Preferred Hc - All Plans | $194 - $1,759 | 21% |
| Aetna | $194 - $1,759 | 21% |
| Midlands Choice - All Plans | $198 - $1,796 | 21% |
| Health Partners - All Plans | $200 - $1,814 | 22% |
| Integrated Hp - All Plans | $200 - $1,814 | 22% |
| Ppo Next - All Plans | $200 - $1,814 | 22% |
| Unicare - All Plans | $200 - $1,814 | 22% |
| Childrens Mercy - All Plans | $204 - $1,851 | 22% |
| Healthy Blue Mcaid - All Other Plans | $204 - $1,851 | 22% |
| Healthwave Mcaid - All Plans | $204 - $1,851 | 22% |
| UnitedHealthcare | $289 - $1,851 | 31% |
| Tricare | $289 - $1,333 | 31% |
| Healthy Blue Mcr Adv | $289 - $1,333 | 31% |
| Providers Care-All Plans | $306 - $2,777 | 33% |
| Choice Care - All Plans | $319 - $1,346 | 34% |
| Blue Cross Blue Shield | $1,142 | 123% |
Consumer Guidance & Cost Commentary
For the CPT code 43239 (Upper endoscopy with biopsy), Cheyenne County Hospital in St. Francis, KS, lists a cash median price of $873.00, which is lower than the facility's negotiated rates of $1,219.00 and the median paid amount of $1,333.00. While the facility's gross charge is $1,028.00, commercial payers negotiate rates that range from $143 to $2,777 depending on the insurance plan, with Blue Cross Blue Shield negotiating a fixed rate of $1,142.00. For patients with high-deductible plans, paying the cash price of $873.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. Patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these can further reduce the final amount owed.
This procedure is benchmarked against Medicare, which sets a fixed reimbursement rate of $926.63 for this service. The facility's cash price of $873.00 is slightly below the Medicare benchmark, whereas the median negotiated rate of $1,219.00 represents a markup of approximately 31% over the Medicare amount. It is important to note that comparing these rates to the hospital's gross charge of $1,028.00 can be misleading, as chargemasters are inflated lists designed to show large potential savings. To ensure accuracy, patients should request an itemized bill to verify that no unb