Upper endoscopy with biopsy
Facility: Kiowa District Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,083
- Cash Discount Price: $912
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Tricare | $445 | 48% |
| UnitedHealthcare | $912 - $1,140 | 98% |
| Health Partners Of Ks-All Plans | $1,003 | 108% |
| Humana | $1,029 | 111% |
| Multiplan-All Plans | $1,072 | 116% |
| Gbs Insurance - All Plans | $1,072 | 116% |
| Triwest-All Plans | $1,083 | 117% |
| Medicare (plans) | $1,083 | 117% |
| Aetna | $1,083 | 117% |
| Medicaid / KanCare | $1,140 | 123% |
| Blue Cross Blue Shield | $1,142 | 123% |
| Healthchoice-All Plans | $1,336 | 144% |
| Providers Care (Wppa)-All Plans | $1,710 | 185% |
| Liberty Healthshare-All Plans | $1,841 | 199% |
Consumer Guidance & Cost Commentary
For the CPT code 43239, "Upper endoscopy with biopsy," Kiowa District Hospital in Kiowa, KS, lists a gross charge of $1,140.00. While the facility's cash median price is $912.00, which is lower than the gross charge, commercial insurance negotiated rates range from $445 to $1,841 depending on the payer. Notably, the lowest negotiated rate of $445 offered by Tricare is significantly lower than the facility's cash price, meaning patients with high-deductible plans might save money by using insurance if their deductible has been met. However, for many commercial payers, the negotiated rates exceed the cash price, illustrating that being in-network does not always guarantee the lowest possible cost.
To understand the true cost of this service, it is helpful to compare these rates against the Medicare benchmark. The Medicare allowed amount for this procedure is $926.63, and the facility's median negotiated rate of $1,083.00 represents a markup of 1.2 times the Medicare rate. This aligns with the general industry observation that fair pricing typically falls between 120% and 150% of the Medicare baseline. Patients should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they must still verify their specific plan details. Additionally, asking the hospital about "self-pay" or "prompt-pay" discounts before scheduling can sometimes result in further reductions, as these incentives bypass the administrative costs associated with insurance claims processing.