Upper endoscopy with biopsy
Facility: Republic County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $701
- Cash Discount Price: $609
- vs. Medicare Baseline: 0.76x 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 |
|---|---|---|
| Rural Carriers-All Plans | $191 - $1,188 | 21% |
| Meritain-All Plans | $202 - $1,258 | 22% |
| Aetna | $202 - $1,258 | 22% |
| UnitedHealthcare | $207 - $1,286 | 22% |
| Midlands Choice-All Plans | $214 - $1,328 | 23% |
| First Health-All Plans | $214 - $1,328 | 23% |
| Cigna | $214 - $1,328 | 23% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Republic County Hospital in Belleville, KS, the cash price of $609.00 is lower than the facility's gross charge of $812.00, though it remains higher than the state average cash median of $318.00. While commercial insurance plans like Rural Carriers and Aetna negotiate rates starting as low as $191, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking prompt-pay discounts. The facility, a voluntary non-profit Critical Access Hospital, lists a cash median of $609.00, which is notably higher than the national cash median of $318.00, suggesting that self-pay patients should verify if the hospital offers specific self-pay or prompt-pay reductions before finalizing payment.
The Medicare benchmark for this procedure is $926.63, which serves as a reliable baseline for evaluating the facility's pricing; the gross charge of $812.00 is approximately 88% of the Medicare amount, indicating a markup that is lower than the typical 200% to 300% seen in commercial negotiations. However, patients must be aware that commercial negotiated rates can vary significantly by payer, ranging from $191 to $1,328 depending on the insurance plan, and should not assume that being in-network guarantees the lowest possible cost. To avoid unexpected balance billing or errors, consumers are advised to request a full itemized bill before paying, as summary bills often obscure individual charges, and to dispute any discrepancies in writing rather than accepting verbal assurances