Upper endoscopy with biopsy
Facility: Saint John Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $872
- Cash Discount Price: $854
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| Medicaid / KanCare | $294 | 32% |
| UnitedHealthcare | $294 - $1,196 | 32% |
| Healthy Blue | $300 - $897 | 32% |
| Celtic | $300 - $1,367 | 32% |
| Blue Cross Blue Shield | $577 - $1,153 | 62% |
| Comp Alliance Workers Comp | $674 | 73% |
| Aetna | $854 - $2,488 | 92% |
| Tricare | $854 | 92% |
| Cigna | $854 | 92% |
| Midland Care Connection | $854 | 92% |
| Medicare (plans) | $854 | 92% |
| Kansas Superior Select | $872 | 94% |
| Well Path | $1,196 | 129% |
| Corizon | $1,196 | 129% |
| Employer Direct Healthcare | $1,196 | 129% |
| Centurion | $1,282 | 138% |
| Naphcare | $1,324 | 143% |
| Oha Networks | $1,442 | 156% |
| Worker Compensation | $1,487 | 160% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy (CPT 43239) at Saint John Hospital in Leavenworth, KS, the cash price is $854.00, which is significantly lower than the facility's gross charge of $4,946.00. While the hospital's negotiated rates with commercial payers range from $294 to $2,488, the cash rate of $854.00 is notably lower than the median negotiated rate of $872.00 and the state average for this procedure. This suggests that for patients with high-deductible plans or those without insurance, paying cash upfront may be the most cost-effective option, as the cash price avoids the administrative markups often embedded in commercial contracts.
When comparing this facility's pricing to federal benchmarks, the Medicare amount of $926.63 serves as a reliable baseline for evaluating the true cost of care. The cash rate of $854.00 is approximately 92% of the Medicare amount, indicating a pricing structure that is competitive and potentially below the typical 120% to 150% markup considered fair. Patients should verify their specific plan's deductible status before scheduling, as commercial negotiated rates can sometimes exceed cash prices if the patient has not yet met their out-of-pocket threshold. Additionally, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which could further reduce the final bill.