Upper endoscopy with biopsy
Facility: Girard Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $116
- Cash Discount Price: $720
- vs. Medicare Baseline: 0.13x 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 - $439 | 13% |
| Humana | $116 | 13% |
| Blue Cross Blue Shield | $116 - $349 | 13% |
| Kansas Superior Select-All Plans | $116 | 13% |
| Aetna | $116 | 13% |
| Ambetter / Centene | $116 | 13% |
| Medicare (plans) | $116 | 13% |
| Uhhis-All Plans | $439 | 47% |
| Multiplan-All Plans | $1,110 | 120% |
Consumer Guidance & Cost Commentary
For this upper endoscopy with biopsy at Girard Medical Center in Girard, KS, the facility's cash median rate is $720.00, which is significantly lower than the negotiated rates paid by major insurers like UnitedHealthcare, Humana, and Blue Cross Blue Shield, all of which range from $116 to $439. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs than paying cash directly. If you have a high-deductible plan, paying the $720 cash median upfront may be more cost-effective than relying on insurance, especially since the negotiated rates for many payers exceed the cash price. It is always advisable to ask the hospital about self-pay or prompt-pay discounts before scheduling, as these can further reduce the final amount owed.
The facility's Medicare benchmarking rate is $926.63, which serves as a reliable baseline for evaluating pricing fairness, as commercial negotiated rates frequently exceed this amount due to administrative overhead and contract dynamics. In this case, the median negotiated amount of $116.00 appears to be a specific allowed amount for certain plan tiers, but the gross charge of $1,200.00 highlights the potential for balance billing if out-of-network services are involved. To avoid unexpected costs, patients should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a surprise bill, you have the right to dispute it under the No Surprises Act, and you