CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Howard County Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $127
  • Cash Discount Price: $775
  • vs. Medicare Baseline: 0.14x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Howard County Medical Center is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $775. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.14x the Medicare baseline. Located in P O Box 406, 1113 Sherman St, St Paul, NE.
Cash / Self-Pay
$775

Average discount available for prompt cash payment at this facility.

Insurance Median
$127

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: $775 (84%)
Insurance Median: $127 (14%)
Cash: $775 (84% of Medicare)
Ins. Median: $127 (14% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $71 - $299 8%
Nebraska Total Care $98 - $137 11%
UnitedHealthcare $98 - $503 11%
Molina Healthcare $100 - $140 11%
Humana $104 - $122 11%
Blue Cross Blue Shield $122 - $1,615 13%
Great Plains $122 13%
Medica Chi $122 13%
Tricare $122 13%
Medica Standard Premier $124 13%
Medica Elevate $125 - $242 13%
Nebraska Total Care - Wellcare $126 14%
Oscar Health $214 23%
Ambetter / Centene $245 26%
Beshp $245 26%
Medica Ifb Aco $246 27%
Medica Chi Aco $254 27%
Medica Choice National $272 29%
Medica Ifb Open Access $315 34%
Midland'S Choice $699 75%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: P O Box 406, 1113 Sherman St, St Paul, NE 68873
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Critical Access Hospitals