Upper endoscopy with biopsy
Facility: Logan County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,153
- Cash Discount Price: $878
- vs. Medicare Baseline: 1.24x 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 |
|---|---|---|
| Humana | $117 - $1,490 | 13% |
| UnitedHealthcare | $117 | 13% |
| Medicaid / KanCare | $285 - $3,511 | 31% |
| Blue Cross Blue Shield | $1,153 | 124% |
| Health Partners - All Plans | $3,336 | 360% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Logan County Hospital in Oakley, KS, the cash price is $878.00, which is significantly lower than the facility's gross charge of $1,973.00. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For instance, UnitedHealthcare and Blue Cross Blue Shield have a fixed negotiated rate of $1,153.00, which is higher than the cash price, whereas Medicaid/KanCare ranges from $285.00 to $3,511.00 depending on the specific plan. This illustrates that for patients with high-deductible plans, paying the cash price directly or utilizing a prompt-pay discount before services are rendered may result in lower out-of-pocket costs compared to relying on insurance reimbursement.
To ensure you are not overcharged, it is critical to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan details and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling. The facility's Medicare benchmark of $926.63 serves as a reliable baseline for evaluating pricing, showing that the cash rate of $878.00 is slightly below the federal average, while the highest negotiated rate of $3,336.00 from