Upper endoscopy with biopsy
Facility: Nemaha Valley Community Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $329
- Cash Discount Price: $765
- vs. Medicare Baseline: 0.36x 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 |
|---|---|---|
| Va Ccn - All Plans | $116 | 13% |
| Humana | $116 - $440 | 13% |
| Aetna | $117 - $850 | 13% |
| Celtic Comm Exch - All Plans | $121 - $329 | 13% |
| Partners Direct Health - All Plans | $127 - $520 | 14% |
| Midlands Choice - All Plans | $317 - $950 | 34% |
| Blue Cross Blue Shield | $323 | 35% |
| Multiplan - All Plans | $420 - $900 | 45% |
| Health Partners - All Plans | $535 - $950 | 58% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median price is $765.00, which is lower than the gross charge of $850.00. While the hospital's negotiated rates with insurance payers range from $116 to $950, the cash price can be a more cost-effective option for patients with high-deductible plans or those without insurance, as it avoids the administrative markup often found in commercial contracts. It is important to note that the facility's negotiated rate of $329.00 is significantly lower than the gross charge, but patients should verify their specific plan's allowed amount, as some in-network rates may still exceed the cash price.
This procedure is billed under CPT code 43239, and the facility's cash price of $765.00 is compared against a Medicare benchmark of $926.63, showing a variance of 0.4. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial negotiated rates can sometimes be higher than cash prices due to multi-layered administrative costs. To ensure you are receiving the best possible rate, you should request a full itemized bill before paying, as summary bills may obscure individual charges, and ask specifically about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid upfront.