Upper endoscopy with biopsy
Facility: St Joseph Health System, LLC
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $345
- Cash Discount Price: $181
- vs. Medicare Baseline: 0.37x 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 |
|---|---|---|
| Amish Aid | $79 - $2,789 | 9% |
| Self Pay | $79 - $2,789 | 9% |
| Lutheran Preferred | $94 - $6,972 | 10% |
| Cigna | $106 - $11,620 | 11% |
| Blue Cross Blue Shield | $119 - $4,215 | 13% |
| Php | $131 - $4,643 | 14% |
| Lutheran Network | $148 - $6,391 | 16% |
| Three Rivers | $148 - $1,144 | 16% |
| Aetna | $151 - $7,902 | 16% |
| Encore Ppo | $168 - $10,458 | 18% |
| Sagamore | $172 - $6,287 | 19% |
| Multiplan | $227 - $9,064 | 24% |
| First Health | $247 - $8,715 | 27% |
| Prime Health Services | $247 - $8,715 | 27% |
| Align Network | $263 - $9,296 | 28% |
| Frontpath Health Coalition | $263 - $9,296 | 28% |
| Advantage Health Solutions | $273 - $9,645 | 29% |
| Allied Benefit Systems | $296 - $10,458 | 32% |
| Medical Mutual Of Ohio | $329 - $11,620 | 36% |
| Parkview Healthplan Services | $329 - $11,620 | 36% |
| Value Options | $329 - $11,620 | 36% |
| Veterans Eval Services | $329 - $331 | 36% |
| UnitedHealthcare | $850 - $6,759 | 92% |
| Tricare | $912 | 98% |
| Humana | $944 - $2,274 | 102% |
| Managed Health Services | $944 - $2,274 | 102% |
| Medicare (plans) | $944 | 102% |
| Department Of Veterans Affairs | $960 | 104% |
| Node Hospice Non Par Agree | $960 | 104% |
| Node Va | $960 | 104% |
| Node Devoted Health Mcr Adv | $963 | 104% |
| In Dept Of Correction | $998 | 108% |
| Node Pphp Mcr Adv | $1,008 | 109% |
| Us Department Of Labor | $1,200 | 130% |
| Lutheran Advanced Network | $1,439 | 155% |
| Encore Work Comp In | $1,727 | 186% |
| Work Comp | $1,919 | 207% |
| Caresource | $2,274 | 245% |
| Medicaid / KanCare | $2,274 | 245% |
| Encore Kba Epo | $2,303 | 249% |
| Php Freedom Network | $2,690 | 290% |
| Encore Kba Ppo | $2,879 | 311% |