Upper endoscopy with biopsy
Facility: Cloud County Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $404
- Cash Discount Price: $480
- vs. Medicare Baseline: 0.44x 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 |
|---|---|---|
| Mpi-All Plans | $156 | 17% |
| Pponext-All Plans | $652 | 70% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Cloud County Health Center in Concordia, KS, the facility's cash median price is $480.00, which is lower than the state average of $652.00. While your insurance plan Mpi-All Plans has a negotiated rate of $156.00, Pponext-All Plans has a negotiated rate of $652.00, which matches the state average. If you have a high-deductible plan where you pay the full negotiated amount before coverage kicks in, paying the cash price of $480.00 upfront could save you money compared to the Pponext-All Plans rate. You should contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling your visit.
The facility's Medicare benchmark amount is $926.63, which serves as the federal baseline for pricing. The cash price of $480.00 is significantly lower than this Medicare amount, indicating a fair rate relative to the government's cost basis. However, the negotiated rate for Pponext-All Plans ($652.00) is higher than the cash price, illustrating that commercial insurance rates can sometimes exceed what a patient pays out-of-pocket. To ensure you receive the most accurate billing, request an itemized CPT-coded bill to verify all charges and avoid summary bills that may hide unbundled codes or services not rendered. If you receive a balance bill from an out-of-network provider, you may be eligible to dispute the amount under the No Surprises Act.