Upper endoscopy with biopsy
Facility: Kearny County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,596
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.80x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 280% of the Medicare baseline (a markup of 180%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $747 - $3,462 | 81% |
| Community Care Health Plan Of | $747 - $3,462 | 81% |
| Humana | $747 | 81% |
| Blue Cross Blue Shield | $747 - $4,328 | 81% |
| Aetna | $2,596 | 280% |
| Wps Gha - Mac J5 Part A | $5,194 | 561% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Kearny County Hospital in Lakin, KS, the facility's negotiated rates range from $747 to $5,194 depending on the insurance plan, while the cash median is not available in the current data. This facility is a Critical Access Hospital with government-local ownership, and its pricing is benchmarked against Medicare, which sets the standard cost at $926.63. The data indicates a significant variance in what different payers will cover, with UnitedHealthcare, Community Care Health Plan Of, and Humana all showing a low-end rate of $747, whereas Blue Cross Blue Shield and Wps Gha - Mac J5 Part A have higher negotiated ceilings of $4,328 and $5,194 respectively. Because commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40%, patients should be aware that the "allowed amount" paid by their insurer may not reflect the true cost of care.
Patients should consider that paying cash upfront might result in a lower total out-of-pocket expense if their insurance plan has a high deductible or if the negotiated rate exceeds the cash price, though the specific cash median is currently unlisted. It is crucial to verify the exact "self-pay" or "prompt-pay" discount offered by the hospital before scheduling, as these discounts can range from 20% to 50% and bypass costly insurance billing cycles. If you receive a bill after using insurance, you should request a full itemized CPT-coded statement to identify any errors, double-billing, or unbundled charges, as over 8