Upper endoscopy with biopsy
Facility: Morris County Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,143
- Cash Discount Price: $1,300
- vs. Medicare Baseline: 1.23x 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $406 | 44% |
| Choice Care Mcr Adv-All Plans | $845 | 91% |
| Blue Cross Blue Shield | $845 - $1,172 | 91% |
| Va Ccn-All Plans | $845 | 91% |
| UnitedHealthcare | $845 - $2,167 | 91% |
| Coventry Mcr | $845 | 91% |
| Cigna | $1,568 | 169% |
| Aetna | $1,942 | 210% |
| Multiplan-All Plans | $1,950 | 210% |
| Coventry Comm-All Other Plans | $1,950 | 210% |
Consumer Guidance & Cost Commentary
For this upper endoscopy with biopsy at Morris County Hospital in Council Grove, Kansas, the facility's cash price of $1,300 is notably higher than the state average of $845, though it remains below the gross chargemaster rate of $2,167. While commercial insurance negotiated rates for this procedure range from $845 to $1,950 depending on the plan, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $1,300. Because the facility is a Critical Access Hospital with government local ownership, it is important to verify your specific plan's allowed amount before scheduling, as some in-network contracts can result in higher out-of-pocket costs than paying directly.
To ensure you are not overcharged, we recommend requesting an itemized billing audit to review every line item and confirm that no services were unbundled or incorrectly charged, as over 80% of hospital bills contain errors. Additionally, since the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, you should dispute any surprise bills immediately rather than paying them out of fear of credit damage. Finally, ask the hospital about prompt-pay discounts, which can reduce your total bill by 20% to 50% if you pay in full upfront, effectively bypassing the administrative costs and delays associated with insurance claims processing.