Upper endoscopy with biopsy
Facility: Phillips County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,223
- Cash Discount Price: $943
- vs. Medicare Baseline: 1.32x 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 |
|---|---|---|
| Blue Cross Blue Shield | $242 - $1,290 | 26% |
| Health Partners-All Plans | $625 - $1,593 | 67% |
| UnitedHealthcare | $625 - $1,593 | 67% |
| Medicaid / KanCare | $625 - $1,593 | 67% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Phillips County Hospital in Phillipsburg, KS, the cash median price is $943.00, which is lower than the facility's gross charge of $1,109.00. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the negotiated rates for in-network payers like Blue Cross Blue Shield, Health Partners, UnitedHealthcare, and Medicaid/KanCare range from $625 to $1,593. These insurance rates often exceed the cash price due to administrative overhead and contract structures, meaning that if your deductible has not been met, paying the cash median of $943.00 could result in lower out-of-pocket costs compared to the allowed amounts your insurer would pay.
It is important to verify your specific plan's negotiated rate before scheduling, as commercial rates can vary significantly even within the same network. Although the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still request a formal itemized bill to ensure no unbundled codes or services not rendered are included in the final charge. If you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the cost. Always compare the facility's rates against state or county averages to understand the local pricing context, and remember that Medicare's benchmark rate for this service is $926.63, providing a clear baseline for evaluating the facility's pricing markup.