Upper endoscopy with biopsy
Facility: Clay County Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $644
- Cash Discount Price: $692
- vs. Medicare Baseline: 0.69x 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 |
|---|---|---|
| Multiplan- All Plans | $127 - $657 | 14% |
| UnitedHealthcare | $376 - $657 | 41% |
| Health Partners - All Plans | $535 - $657 | 58% |
| Aetna | $644 | 69% |
| Wppa/Providrs Care- All Plans | $644 | 69% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Clay County Medical Center in Clay Center, KS, the cash price is $692.00, which matches the facility's median paid amount. While the Medicare benchmark for this service is $926.63, indicating that the cash rate is lower than the federal baseline, the negotiated rates paid by major insurers like UnitedHealthcare and Multiplan range from $376 to $657. It is important to note that for patients with high-deductible plans, paying the cash price of $692.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overheads. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
This facility, a Critical Access Hospital with government-local ownership, has a facility rating of 3 and is located in zip code 67432. The data reflects billing transparency for the 2026-06 vintage, showing that while the gross charge is $692.00, the actual amount paid by insurers varies significantly by plan. Consumers should be aware that summary bills often obscure individual costs, so requesting a full itemized CPT-coded statement is a critical step to identify any errors or unbundled charges before paying. Furthermore, if a patient receives a balance bill from an out-of-network provider at this in-network facility, they may be entitled to protections under the No Surprises Act, which bans surprise billing for emergency and non-emergency services.