Upper endoscopy with biopsy
Facility: Stevens County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,577
- Cash Discount Price: $1,813
- vs. Medicare Baseline: 1.70x 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 | $671 | 72% |
| Aetna | $691 - $1,813 | 75% |
| Blue Cross Blue Shield | $1,096 - $1,153 | 118% |
| First Health - All Plans | $1,632 | 176% |
| Wppa - All Plans | $1,722 | 186% |
| Medicaid / KanCare | $1,813 | 196% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Stevens County Hospital in Hugoton, KS, the cash price is $1,813, which matches the facility's gross charge and the median paid by Medicaid/KanCare. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial insurance plans often pay significantly less than the cash rate; for instance, Aetna plans paid a median of $671, and Humana paid the same amount, whereas Aetna's highest plan paid the full $1,813. Because commercial negotiated rates can sometimes exceed the cash price, patients with high-deductible plans may find it financially advantageous to pay the $1,813 cash rate directly, provided they secure a "self-pay" or "prompt-pay" discount before scheduling. It is crucial to verify these discounts with the hospital directly, as waiting until after an insurance claim is processed may result in the facility submitting a claim that voids any potential cash savings.
The Medicare benchmark for this service is $926.63, which serves as a reliable baseline for evaluating the facility's pricing markup rather than the inflated gross charge. The facility's cash rate of $1,813 represents a 1.7x multiplier compared to the Medicare amount, indicating a significant markup above the federal cost basis. When reviewing your own bill, ensure you receive a detailed itemized statement rather than a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a balance bill from an out-of-network provider, even at an in-network facility, you may have protections under the