Upper endoscopy with biopsy
Facility: University Of Kansas Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,809
- Cash Discount Price: $2,106
- vs. Medicare Baseline: 1.95x 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 |
|---|---|---|
| Sedgwick Claims Management Services [53201618] | $1,487 | 160% |
| Alt Bnsf Railway Co [503301503] | $1,487 | 160% |
| Gallagher Bassett [5032000103] | $1,487 | 160% |
| Prime Health Services [503999912] | $1,487 | 160% |
| Workers Comp [503999901] | $1,487 - $1,792 | 160% |
| Lasso Healthcare [503999926] | $1,792 | 193% |
| Ku Athletics [503200094] | $1,792 | 193% |
| Triwest [503201703] | $1,792 | 193% |
| Medicare (plans) | $1,792 - $1,827 | 193% |
| UnitedHealthcare | $1,792 - $2,866 | 193% |
| Humana | $1,792 - $1,827 | 193% |
| Tricare | $1,792 | 193% |
| Devoted [503200068] | $1,792 | 193% |
| Aetna | $1,792 - $2,508 | 193% |
| Allwell [503200078] | $1,845 | 199% |
| Blue Cross Blue Shield | $1,845 - $3,843 | 199% |
| American Health Plans [503200968] | $1,881 | 203% |
| Centurion [5032000966] | $2,329 | 251% |
| Ambetter / Centene | $3,046 | 329% |
| Wellfit [503301514] | $3,404 | 367% |
| Oscar [503201609] | $3,404 | 367% |
| Centivo [5032000982] | $3,404 | 367% |
| 6 Degrees Health [503999050] | $3,494 - $4,479 | 377% |
| Alt Wppa [5032000964] | $3,583 | 387% |
| Occunet [503999930] | $3,762 | 406% |
| Fort Hays State Student Athletes [5032000960] | $3,762 | 406% |
| Multiplan [503200057] | $4,837 | 522% |
| Claimdoc [503301509] | $4,837 | 522% |
| Advanced Medical Pricing Solutions [503301513] | $5,375 | 580% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at University Of Kansas Hospital, the cash price is $2,106, which is significantly lower than the negotiated rates paid by insurance companies. While the facility's cash rate is higher than the state average of $2,106, it remains the most affordable option for patients without insurance or those with high-deductible plans where the insurance negotiated rate exceeds the cash price. The hospital offers a prompt-pay discount for upfront payment, which can further reduce the cost, but patients should verify this with the billing department before scheduling to ensure their payment is classified as self-pay rather than insurance-covered.
The facility's negotiated rates vary widely among payers, ranging from $1,487 to $5,375, with the median negotiated amount being $1,809. These rates are based on contracts with insurers and are often higher than the Medicare benchmark of $926.63, reflecting the administrative costs and markup inherent in commercial insurance billing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to request an itemized bill to identify any errors or unbundled charges before finalizing payment.