Upper endoscopy with biopsy
Facility: Goodland Regional Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,153
- Cash Discount Price: $1,478
- vs. Medicare Baseline: 1.24x 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 |
|---|---|---|
| Wppa | $850 - $2,056 | 92% |
| UnitedHealthcare | $900 - $2,056 | 97% |
| Blue Cross Blue Shield | $1,153 | 124% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Goodland Regional Medical Center in Goodland, KS, the cash price is $1,478, which is lower than the facility's negotiated rates of $1,153 for in-network plans like Wppa, UnitedHealthcare, and Blue Cross Blue Shield. This facility is a Critical Access Hospital with a government-local ownership structure, and its pricing reflects a standard markup of 1.2 times the Medicare amount of $926.63. While the cash price is higher than the median negotiated rate, patients with high-deductible plans may find paying out-of-pocket upfront more cost-effective if their insurance allows the full negotiated amount, as the administrative costs of claims processing often inflate the final bill. It is important to note that this facility is located in a rural area (ZIP 67735), and while specific county or state average comparisons are not provided in the current data, patients should always verify if the facility offers prompt-pay discounts, which can reduce the final balance by 20% to 50% when paid in full within 30 days.
When reviewing your bill, ensure you receive an itemized statement that lists every specific CPT code and service rendered, as summary bills often hide unbundled charges or services not received. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to confirm that all ancillary services, such as laboratory tests or imaging, were billed correctly and at the allowed amount. If you receive a bill that exceeds the negotiated rate or Medicare benchmark, you should request a formal written audit dispute rather than paying immediately, as