Upper endoscopy with biopsy
Facility: Wesley Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,472
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.59x 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 |
|---|---|---|
| UnitedHealthcare | $294 | 32% |
| Medicaid / KanCare | $302 | 33% |
| Amerigroup | $305 | 33% |
| Aetna | $305 - $2,454 | 33% |
| Usa Managed Care | $711 | 77% |
| First Health | $1,413 | 152% |
| Multiplan | $1,472 | 159% |
| Blue Cross Blue Shield | $1,934 | 209% |
| United | $2,704 | 292% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Wesley Medical Center in Wichita, KS, the negotiated rates paid by insurance carriers range from $294 to $2,704, with a median negotiated amount of $1,472. This median rate is significantly higher than the state average, reflecting the facility's proprietary ownership and the administrative costs associated with processing insurance claims. While commercial insurance contracts establish a ceiling to protect in-network members, these rates often exceed the true cost of care. For patients with high-deductible plans who have not yet met their deductible, paying the cash price or utilizing a prompt-pay discount may result in lower out-of-pocket costs compared to the insurance negotiated rate, provided the facility offers a self-pay classification before scheduling.
The Medicare benchmark for this service is $926.63, which serves as a scientifically validated baseline for the true cost of delivery. The facility's negotiated rates average 1.6 times the Medicare amount, indicating a markup typical of commercial billing structures that include claims processing and utilization review fees. To ensure you are not overcharged, it is essential to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you receive a balance bill for out-of-network ancillary services, you may be entitled to protections under the No Surprises Act, which prohibits balance billing for emergency and non-emergency care at in-network facilities. Always verify your specific plan details and ask the hospital directly about prompt-pay discounts or self-pay rates prior to your visit.