Upper endoscopy with biopsy
Facility: Hodgeman County Health Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,612
- Cash Discount Price: $1,832
- vs. Medicare Baseline: 1.74x 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 | $1,096 - $1,153 | 118% |
| Medicaid / KanCare | $1,466 - $2,290 | 158% |
| Humana | $1,466 | 158% |
| Triwest - All Plans | $1,466 | 158% |
| UnitedHealthcare | $1,466 - $2,176 | 158% |
| Aetna | $1,832 | 198% |
| First Health - All Plans | $2,061 | 222% |
| Wppa (Provdrscare) - All Plans | $2,176 | 235% |
| Health Partners - All Plans | $2,176 | 235% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Hodgeman County Health Center in Jetmore, Kansas, the cash price is $1,832, which is significantly higher than the facility's negotiated rate of $1,612. This cash rate exceeds the state average for this procedure, indicating that paying out-of-pocket may not be the most cost-effective option for patients with high-deductible plans. While the cash price appears lower than the gross charge of $2,290, commercial insurance carriers like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $1,096 to $2,176, meaning many insured patients will pay less than the cash price. Patients should verify their specific plan's deductible status and allowed amount before scheduling, as paying the full negotiated rate without meeting a deductible can result in substantial out-of-pocket costs.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the provider's full charge and your insurance payment, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Always dispute any unexpected charges in writing to avoid credit damage and ensure your rights are protected.