Upper endoscopy with biopsy
Facility: Holton Community Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $918
- Cash Discount Price: $887
- vs. Medicare Baseline: 0.99x 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 | $116 - $1,715 | 13% |
| Aetna | $116 - $1,715 | 13% |
| Humana | $117 - $918 | 13% |
| Kansas Superior Select - All Plans | $118 - $927 | 13% |
| Medicaid / KanCare | $285 - $1,715 | 31% |
| Blue Cross Blue Shield | $1,142 | 123% |
| Preferred Health Fn Select - All Other Plans | $1,423 | 154% |
| Preferred Health Freedom | $1,423 | 154% |
| Preferred Health Professionals | $1,423 | 154% |
| Wppa Providers - All Plans | $1,629 | 176% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Holton Community Hospital in Holton, KS, the cash median price is $887.00, which is lower than the facility's gross charge of $1,183.00. While the facility's negotiated rates vary significantly by payer—ranging from a low of $116 to a high of $1,715—the cash price may offer the best value 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 while the facility is a Critical Access Hospital in Kansas, the data does not provide specific state or county average benchmarks for comparison; however, patients should always verify if their specific insurance plan has a lower allowed amount than the cash price before deciding to pay out-of-pocket.
Patients should be aware that commercial insurance rates for this service can sometimes exceed the cash price due to the costs of claims processing and contract management, which can inflate the baseline price by 20% to 40%. To ensure you are not overpaying, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, if you have insurance, do not accept a summary bill without requesting a detailed, itemized statement to check for errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal written audit dispute.