Upper endoscopy with biopsy
Facility: Stanton County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,125
- Cash Discount Price: $1,047
- vs. Medicare Baseline: 1.21x 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 |
|---|---|---|
| Healthy Blue Mcaid | $207 - $1,411 | 22% |
| Blue Cross Blue Shield | $230 - $1,341 | 25% |
| Healthy Blue Mcr Adv - All Other Plans | $238 - $1,383 | 26% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Stanton County Hospital in Johnson, KS, the cash price is $1,047.00, which matches the cash median for this service. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates vary significantly by insurer, ranging from $207 to $1,411 depending on the plan. It is important to note that cash-pay can sometimes be the most cost-effective option for patients with high-deductible plans, as the insurance negotiated rates often exceed the cash price. To ensure you receive the best possible rate, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
When evaluating the cost of this service, it is more accurate to compare rates against the Medicare benchmark rather than the hospital's gross charges. The Medicare amount for this procedure is $926.63, and the facility's cash rate of $1,047.00 represents a 1.2x markup relative to Medicare. This aligns with fair pricing standards, which typically range from 120% to 150% of the Medicare rate, whereas commercial negotiated rates can average 200% to 300% of Medicare. Since the data provided does not include specific state or county average comparisons for this code, we advise verifying the facility's pricing against local averages through your state's health insurance marketplace or the hospital's price transparency portal to ensure you are receiving a competitive rate.