Upper endoscopy with biopsy
Facility: Mitchell County Hospital Health Systems
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $388
- Cash Discount Price: $412
- vs. Medicare Baseline: 0.42x 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 | $116 - $435 | 13% |
| First Health-All Plans | $387 | 42% |
| Aetna | $387 | 42% |
| Triwest Well Mark All Plans | $389 | 42% |
| Auxiant-All Plans | $457 | 49% |
| Health Partners Ks-All Plans | $535 | 58% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy (CPT 43239) at Mitchell County Hospital Health Systems in Beloit, KS, the facility's cash price of $412.00 is notably lower than the median paid amount of $256.00, suggesting that paying out-of-pocket directly may offer a more affordable option for those without insurance or with high-deductible plans. While the facility is a Critical Access Hospital owned by the local government, its negotiated rates for commercial payers range from $116 to $535, with UnitedHealthcare paying as low as $116 and Health Partners Ks-All Plans paying the highest single rate of $535. This variation highlights that being in-network does not guarantee the lowest possible price, as different insurance contracts establish different ceilings. For patients, it is crucial to verify the specific allowed amount for their plan before scheduling, as some in-network facilities may charge significantly more than others for the same service.
When evaluating the cost against federal standards, the facility's Medicare amount of $926.63 serves as the most reliable benchmark for understanding the true cost of care. The commercial negotiated rates observed here generally fall below the Medicare benchmark, which often reveals that commercial pricing can be more efficient than the federal baseline. However, patients should be aware that the gross charge of $458.00 represents the maximum billed amount before any discounts or insurance adjustments are applied. To minimize costs, individuals should proactively ask the billing department about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid upfront, and request an itemized bill to ensure