Upper endoscopy with biopsy
Facility: Kiowa County Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,153
- Cash Discount Price: $870
- 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 |
|---|---|---|
| UnitedHealthcare | $369 - $1,585 | 40% |
| Health Partners Of Ks-All Plans | $406 - $1,395 | 44% |
| Humana | $410 - $1,411 | 44% |
| Medica Prime Mcare Cost-All Plans | $410 - $1,411 | 44% |
| Aetna | $410 - $1,411 | 44% |
| Blue Cross Blue Shield | $410 - $1,411 | 44% |
| Celtic Comml Exchange-All Other Plans | $410 - $1,411 | 44% |
| Medicaid / KanCare | $461 - $1,585 | 50% |
| Providrs Care/Wppa-All Plans | $692 - $2,378 | 75% |
Consumer Guidance & Cost Commentary
For the procedure of an upper endoscopy with biopsy at Kiowa County Memorial Hospital in Greensburg, KS, the facility's cash median price is $870.00, which is lower than the negotiated rates paid by most major insurance carriers. While the facility's cash price is below the gross charge of $1,023.00, patients with high-deductible plans may find paying out-of-pocket cheaper than relying on insurance, as many payers have negotiated rates exceeding the cash price. For instance, UnitedHealthcare and Medicaid/KanCare have high-end negotiated rates reaching $1,585.00, whereas the cash option remains fixed at $870.00. Additionally, the facility's cash rate is lower than the state average for this service, making it a potentially cost-effective option for self-pay patients.
Patients should be aware that while the facility is an in-network Critical Access Hospital, balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act. However, to ensure the lowest possible cost, it is crucial to request a "prompt-pay" discount before scheduling, which can reduce the bill by 20% to 50% for upfront payment. Since the facility is government-owned, they may also offer self-pay or prompt-pay discounts that are not automatically applied. Finally, if a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected to reduce debt.