CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kearney County Health Services Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,740
Cash Discount Price: $3,152
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Kearney County Health Services Hospital is $2,740. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,152. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.96x the Medicare baseline. Located in 727 East 1St St, Minden, NE.

Cash / Self-Pay

$3,152

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,740

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)

Cash / Self-Pay: $3,152 (340%)

Insurance Median: $2,740 (296%)

Cash: $3,152 (340% of Medicare)

Ins. Median: $2,740 (296% of 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 296% of the Medicare baseline (a markup of 196%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$528 - $3,753	57%
Medica	$528 - $13,375	57%
Humana	$580 - $3,753	63%
UnitedHealthcare	$580 - $6,483	63%
Total Care	$586 - $3,866	63%
Aetna	$609 - $12,966	66%
Great Plains	$609 - $3,941	66%
Healthy Blue	$609 - $3,941	66%
Multiplan	$1,034 - $6,688	112%
Healthnet	$1,055 - $6,824	114%
Triwest	$1,055 - $6,824	114%
Molina	$1,087 - $7,029	117%
Private Healthcare Systems And Multiplan	$1,735 - $11,222	187%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $3,152.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kearney County Health Services Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.