Upper endoscopy with biopsy
Facility: Sheridan County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,614
- Cash Discount Price: $2,345
- vs. Medicare Baseline: 1.74x 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 Insurance | $1,419 | 153% |
| Blue Cross Blue Shield | $1,614 | 174% |
| UnitedHealthcare | $2,228 | 240% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Sheridan County Hospital in Hoxie, KS, the cash price is $2,345.00, which matches the facility's median paid amount. While this cash rate is significantly higher than the state average for this procedure, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate across payers is $1,614.00, which is lower than the cash price, suggesting that using insurance may result in lower out-of-pocket costs for patients with active coverage. However, patients with high-deductible plans should verify their deductible status before relying on insurance, as they may still be responsible for the full negotiated amount if they have not yet met their plan's threshold.
To minimize potential balance billing or unexpected charges, patients should request a full itemized bill before finalizing payment, as summary invoices can obscure specific line items and unbundled codes. Although the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to ensure that ancillary services like laboratory tests are also covered under the network agreement. Additionally, patients should inquire about prompt-pay discounts or self-pay rates directly with the hospital, as paying upfront can sometimes bypass the higher administrative costs associated with insurance claims processing. Given that the facility is a Critical Access Hospital with government-local ownership, comparing the final allowed amount to the Medicare benchmark of $926.63 provides a clear view of the markup, with the cash price representing a substantial increase over the federal baseline.