Upper endoscopy with biopsy
Facility: Ellsworth County Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,310
- Cash Discount Price: $1,456
- vs. Medicare Baseline: 1.41x 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $684 | 74% |
| Humana | $684 - $1,383 | 74% |
| Va Ccn-All Plans | $684 | 74% |
| Triwest -All Plans | $684 | 74% |
| UnitedHealthcare | $946 - $1,456 | 102% |
| Blue Cross Blue Shield | $1,085 - $1,142 | 117% |
| First Health - All Plans | $1,310 | 141% |
| Aetna | $1,310 | 141% |
| Cigna | $1,383 | 149% |
| Coventry Mcaid-All Plans | $1,456 | 157% |
| Medicaid / KanCare | $1,456 | 157% |
| Healthy Blue Mcaid- All Other Plans | $1,456 | 157% |
| Providers Care-Wppa-All Plans | $2,184 | 236% |
Consumer Guidance & Cost Commentary
For the CPT code 43239, "Upper endoscopy with biopsy," Ellsworth County Medical Center in Ellsworth, KS, lists a cash median price of $1,456.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this procedure, which is $786.00. While the facility is a Critical Access Hospital with a Proprietary ownership structure, patients should be aware that paying cash upfront may not always be the most economical option. If you have a high-deductible plan, your insurance negotiated rate could exceed the cash price; for instance, UnitedHealthcare's allowed amount for this service is $1,456.00, identical to the cash rate, whereas other payers like Healthy Blue Mcr Adv have a negotiated rate of only $684.00. It is crucial to verify your specific plan's allowed amount before scheduling, as assuming that in-network coverage equals the lowest possible price is a common billing pitfall.
To ensure you are receiving fair value, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. When reviewing your statement, ignore the facility's inflated chargemaster list and instead compare your final allowed amount directly to the Medicare benchmark of $926.63 for this procedure. The facility's cash rate of $1,456.00 represents a markup of 1.4 times the Medicare amount, which falls within the typical range where commercial rates can be 200% to 300