Upper endoscopy with biopsy
Facility: Graham County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,171
- Cash Discount Price: $1,500
- vs. Medicare Baseline: 1.26x 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 |
|---|---|---|
| Medicaid / KanCare | $470 | 51% |
| UnitedHealthcare | $470 - $1,425 | 51% |
| Medicare (plans) | $1,125 | 121% |
| Blue Cross Blue Shield | $1,142 | 123% |
| Celtic Commercial-All Other Plans | $1,238 | 134% |
| Wppa (Providers Care)-All Plans | $1,425 | 154% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Graham County Hospital in Hill City, KS, the cash price is $1,500.00, which matches the facility's median negotiated rate of $1,425.00 and the state average. While this facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial payers like UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $470 to $1,425, significantly lower than the cash price. This discrepancy highlights a common billing scenario where in-network insurance plans may result in lower out-of-pocket costs for patients with high deductibles, as the insurance negotiated rate often exceeds the cash price. However, because the cash price here is identical to the median negotiated amount, patients with low deductibles or those without insurance may find paying the full cash price of $1,500.00 to be the most straightforward option, potentially avoiding complex claim processing delays.
To ensure you receive the best possible rate, it is crucial to verify your specific plan's allowed amount before scheduling, as commercial rates can vary widely even within the same network. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is important to confirm that all ancillary services, such as laboratory tests or imaging, are also covered under your plan to avoid unexpected charges. If you are self-pay, you should explicitly request a "prompt-pay" discount before check-in, as hospitals often offer fee reductions of 20% to 50% for upfront payments that bypass administrative claim processing costs. Finally, always demand a detailed, itemized bill before paying; since over