Upper endoscopy with biopsy
Facility: Great Plains Of Sabetha
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $654
- Cash Discount Price: $681
- vs. Medicare Baseline: 0.71x 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 |
|---|---|---|
| Celtic Mcr Adv | $116 - $911 | 13% |
| Aetna | $117 - $1,769 | 13% |
| UnitedHealthcare | $117 - $1,751 | 13% |
| Celtic Comm Exchange-All Other Plans | $144 - $1,138 | 16% |
| Medicaid / KanCare | $285 - $1,751 | 31% |
| Great West Healthcare-All Plans | $562 - $1,488 | 61% |
| Century/Wppa/Providers-All Plans | $595 - $1,663 | 64% |
| Multiplan-Phcs-All Plans | $628 - $1,663 | 68% |
| Federated Mutual Ins-All Plans | $635 - $1,681 | 69% |
| Cigna | $647 - $1,663 | 70% |
| Humana | $647 - $1,663 | 70% |
| Blue Cross Blue Shield | $681 - $1,751 | 73% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Great Plains Of Sabetha in Sabetha, KS, the cash price is $681.00, which matches the facility's cash median. This rate is significantly lower than the negotiated rates charged to insurance plans, with the lowest allowed amount being $116 and the highest reaching $1,751 across 12 payers. While Medicare sets a benchmark of $926.63 for this service, the facility's cash price is 73% of that amount. Patients with high-deductible plans or those without insurance may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash rate due to administrative overhead and contract structures. It is advisable to confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final cost.
To ensure you are not overcharged, it is important to understand that commercial insurance rates are often inflated by administrative costs and lack the transparency of Medicare benchmarks. Although the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like labs or emergency care are billed separately. If you receive a bill, always request a full itemized statement showing specific CPT codes rather than accepting a summary invoice, as errors such as double-billing or unbundled charges are common. Disputing any discrepancies in writing provides the best protection against medical debt, ensuring that the final amount reflects the true cost of care rather than inflated chargemaster lists.