Upper endoscopy with biopsy
Facility: Minneola District Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,395
- Cash Discount Price: $1,085
- vs. Medicare Baseline: 1.51x 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 |
|---|---|---|
| Va Community Care Program-All Plans | $1,038 | 112% |
| Humana | $1,038 | 112% |
| UnitedHealthcare | $1,038 - $1,550 | 112% |
| Blue Cross Blue Shield | $1,153 | 124% |
| Providrs Care Network-All Plans | $1,318 | 142% |
| Corporate Plan Management-All Plans | $1,318 | 142% |
| Triwest-All Plans | $1,395 | 151% |
| Preferred Health Care (Coventry)-All Other Plans | $1,395 | 151% |
| Aetna | $1,472 - $1,550 | 159% |
| Phc (Coventry) Leased Network | $1,472 | 159% |
| Health Partners Of Kansas-All Plans | $1,472 | 159% |
| Medicaid / KanCare | $1,550 | 167% |
Consumer Guidance & Cost Commentary
For the CPT code 43239, Upper endoscopy with biopsy, Minneola District Hospital in Kansas has a cash median price of $1,085.00, which is lower than the facility's negotiated rate of $1,395.00. While the facility is a Critical Access Hospital in Minneola, KS, the data provided does not include specific county or state average comparisons for this procedure. Patients should note that cash-pay options can sometimes be more cost-effective than insurance claims, particularly if their plan has a high deductible or if the insurance negotiated rate exceeds the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling the service.
The Medicare benchmark for this service is $926.63, and the facility's cash rate of $1,085.00 represents a 1.5x markup relative to the Medicare amount. Commercial insurance payers have negotiated rates ranging from $1,038 to $1,550, with UnitedHealthcare showing a range of $1,038 to $1,550 across three plans. Because commercial rates often include administrative overhead and contract structures that can inflate the baseline price by 20% to 40%, patients should verify their specific plan's allowed amount rather than assuming the in-network rate is the lowest possible. If you receive a summary bill, request a full itemized CPT-coded statement to ensure there are no errors, unbundled charges, or services not rendered before finalizing payment.