Upper endoscopy with biopsy
Facility: Osborne County Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,464
- Cash Discount Price: $1,374
- vs. Medicare Baseline: 1.58x 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 |
|---|---|---|
| UnitedHealthcare | $1,229 | 133% |
| Health Partners Of Kansas | $1,391 | 150% |
| Wppa | $1,536 | 166% |
| Blue Cross Blue Shield | $1,585 | 171% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy procedure at Osborne County Memorial Hospital, the cash price of $1,374 is lower than the facility's gross charge of $1,617. While the facility is a Critical Access Hospital in Osborne, Kansas, the data does not provide specific county or state average rates for comparison. However, the cash price is notably lower than the median negotiated rates paid by major payers such as UnitedHealthcare ($1,229), Health Partners Of Kansas ($1,391), Wppa ($1,536), and Blue Cross Blue Shield ($1,585). This suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to using insurance, as the insurer's allowed amount may exceed the cash rate. Patients should verify their specific plan's deductible status and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not inadvertently paying higher negotiated rates.
It is important to understand that the $1,617 gross charge represents the facility's full list price, which is often inflated to make discounts appear larger; the true benchmark for fair pricing is the Medicare amount of $926.63. The cash price of $1,374 is approximately 1.6 times the Medicare rate, which falls within the typical range of fair pricing (120% to 150% of Medicare) rather than the commercial average of 200% to 300%. If you receive a bill that includes charges for services not rendered, unbundled codes,