Upper endoscopy with biopsy
Facility: Scott County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,270
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.37x 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 | $294 - $2,011 | 32% |
| Humana | $889 | 96% |
| Blue Cross Blue Shield | $1,153 | 124% |
| Wppa | $1,200 - $1,270 | 130% |
| Aetna | $1,905 | 206% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Scott County Hospital in Scott City, KS, the facility's negotiated rates range from $889 to $2,011 depending on the insurance carrier, with a median negotiated amount of $1,270. This commercial rate is significantly higher than the Medicare benchmark of $926.63, reflecting the typical markup found in private insurance contracts. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that cash-pay options are not listed in this report. However, for individuals with high-deductible plans, paying the full cash price upfront could potentially be more cost-effective than the insurance negotiated rate if the patient's out-of-pocket costs exceed the facility's cash price, though specific cash rates are not available for this service.
It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan details before scheduling. If you have insurance, the hospital will submit a claim to your carrier, and you will be responsible for your deductible and any applicable copays or coinsurance up to the allowed amount. If you choose to pay out-of-pocket, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before check-in, as these can reduce the total cost by 20% to 50% if paid in full within a short window. Additionally, if you receive a bill, always request a detailed, itemized statement to review every code and charge, as over 80% of hospital bills contain errors that can be disputed to lower your final payment.