Upper endoscopy with biopsy
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $703
- Cash Discount Price: $514
- vs. Medicare Baseline: 0.76x 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 |
|---|---|---|
| Black Lung [6055] | $703 | 76% |
| Hooray Health [8000] | $703 | 76% |
| Oncology Patient Assistance Programs [2295] | $703 | 76% |
| Blue Cross Blue Shield | $703 | 76% |
| Healthcare Highways [2210] | $703 | 76% |
| Aetna | $703 | 76% |
| Web Tpa [2115] | $703 | 76% |
| Lucent Health [6000] | $703 | 76% |
| Department Of Corrections [1340] | $857 | 92% |
| Healthpartners [1500] | $991 | 107% |
| Cigna | $991 | 107% |
| National Association Of Letter Carriers [1695] | $991 | 107% |
| American Postal Workers Union [1070] | $991 | 107% |
| Humana | $1,011 | 109% |
| First Health [1375] | $1,332 | 144% |
| American Healthcare [1055] | $1,332 | 144% |
| Multiplan [1680] | $1,332 | 144% |
| Administrative Concepts [1005] | $1,332 | 144% |
| Coventry Healthcare [1320] | $1,405 | 152% |
| Ks Disability Determination [6090] | $1,714 | 185% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy (CPT 43239) at the University Of Kansas Health System - St Francis Campus in Topeka, KS, the facility's negotiated rates for in-network payers average $703, which is significantly lower than the facility's gross charge of $1,714. While the facility's cash-pay median price of $514 is the lowest rate available, commercial insurance contracts often result in higher out-of-pocket costs for patients who have not yet met their deductible. The facility's negotiated rate of $703 exceeds the cash price, illustrating that for patients with high-deductible plans, paying out-of-pocket upfront can sometimes be more cost-effective than relying on insurance, provided the patient has the funds available. Additionally, the facility offers a prompt-pay discount for those who settle their bill in full within a short window, which can further reduce the final amount owed.
When evaluating the cost against federal standards, the facility's Medicare benchmark amount of $926.63 serves as a reliable baseline for understanding the true cost of care. The facility's cash rate of $514 is approximately 55% of the Medicare amount, indicating a substantial markup on the commercial side. It is important to note that while the facility is a voluntary non-profit church-owned acute care hospital, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary by payer and can sometimes be higher than the cash price. To ensure you are receiving the best possible rate, we recommend requesting a self-pay or prompt-pay classification prior to your visit and reviewing your itemized bill to confirm that no unnecessary charges or unbundled codes have been applied