Upper endoscopy with biopsy
Facility: Ascension Via Christi Hospitals Wichita, Inc.
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $876
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Saint Lukes Health Systems | $867 | 94% |
| Va | $867 | 94% |
| Medicare (plans) | $867 - $884 | 94% |
| Vc Hope | $867 | 94% |
| Via Christi Research | $867 | 94% |
| Humana | $867 | 94% |
| UnitedHealthcare | $884 - $2,428 | 95% |
| Blue Cross Blue Shield | $884 | 95% |
| Corizon | $1,084 | 117% |
| Smarthealth | $1,214 | 131% |
| Medicaid / KanCare | $1,474 | 159% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Ascension Via Christi Hospitals Wichita, Inc., the negotiated rates range from $867 to $2,428 depending on the insurance carrier. While most payers, including Saint Lukes Health Systems and Va, have a single allowed amount of $867, UnitedHealthcare offers a wider range up to $2,428. It is important to note that cash-pay rates are not available for this service, so patients cannot utilize self-pay discounts or prompt-pay incentives to lower their out-of-pocket costs. Since there is no cash option, patients should verify their specific plan's deductible status and out-of-pocket maximums, as the negotiated rates may exceed what a patient would pay if they had met their deductible.
The facility's pricing is benchmarked against the Medicare rate of $926.63, which serves as a reliable baseline for evaluating commercial pricing. The median negotiated rate across all payers is $876.00, which is slightly lower than the Medicare amount, indicating that the facility's contracts are competitive relative to the federal standard. Because this is an in-network facility for the listed payers, balance billing is not a concern for covered services under the No Surprises Act. Patients should still request an itemized bill to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.