Upper endoscopy with biopsy
Facility: Greeley County Health Services
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $234
- Cash Discount Price: $912
- vs. Medicare Baseline: 0.25x 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 |
|---|---|---|
| Medicare (plans) | $230 | 25% |
| Veterans Affairs Community Care Network | $230 | 25% |
| Aetna | $234 | 25% |
| Medicaid / KanCare | $234 | 25% |
| Blue Cross Blue Shield | $1,497 | 162% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Greeley County Health Services in Tribune, Kansas, the facility's cash median price of $912.00 is significantly lower than the negotiated rates charged to major payers like Blue Cross Blue Shield ($1,497.00) and Aetna ($234.00). This price difference highlights the potential savings for patients with high-deductible plans, as paying cash upfront can sometimes be cheaper than the amount their insurance would allow, especially when the negotiated rate exceeds the cash price. While the facility is a Critical Access Hospital owned by the local government, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final bill by bypassing costly insurance claims processing.
When comparing this service to broader benchmarks, the facility's cash rate of $912.00 is notably lower than the Medicare benchmark amount of $926.63 for this CPT code, suggesting a pricing structure that aligns closely with the federal government's cost-based reimbursement standards. Although the data does not provide specific state or county average figures for comparison, the absence of a median paid amount indicates that commercial insurance rates vary widely, with the lowest negotiated rate among the listed payers being $234.00. Consumers are advised to request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered, and to dispute any balance billing immediately if they receive a bill exceeding the allowed amount, particularly under federal protections like the No Surprises Act.