Upper endoscopy with biopsy
Facility: Hiawatha Community Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $185
- Cash Discount Price: $631
- vs. Medicare Baseline: 0.20x 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 |
|---|---|---|
| Ambetter / Centene | $113 | 12% |
| Humana | $116 | 13% |
| UnitedHealthcare | $116 - $142 | 13% |
| Aetna | $116 - $471 | 13% |
| Centrus Health Direct - All Plans | $139 | 15% |
| Multiplan - All Plans | $173 | 19% |
| Oscar - All Plans | $185 | 20% |
| Midlands Choice - All Plans | $317 | 34% |
| Preferred Hlth - All Plans | $417 | 45% |
| Wppa Providrs Care - All Plans | $461 | 50% |
| Cigna | $535 | 58% |
| Healthy Blue Mcaid - All Plans | $574 - $688 | 62% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $631.00, which matches the facility's cash median. This rate is significantly lower than the Medicare benchmark of $926.63, indicating a markup of only 68% compared to the federal standard. While the facility's negotiated rates with insurance payers range from $113 to $688, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $631.00 rate is lower than the negotiated amounts charged to many in-network members, effectively bypassing the higher costs associated with insurance billing cycles.
To ensure you receive the most accurate and lowest possible rate, it is recommended to explicitly request a "self-pay" or "prompt-pay" discount before scheduling your visit, as these upfront payment incentives can further reduce the final bill. If you are using insurance, be aware that the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities, but you should still verify your specific plan's allowed amount, which in this case varies widely between $113 and $688 depending on the carrier. Additionally, if you receive a summary bill, always demand a full itemized CPT-coded statement to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected through a formal written audit dispute.