Upper endoscopy with biopsy
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $867
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| UnitedHealthcare | $225 - $2,428 | 24% |
| Medicaid / KanCare | $234 - $236 | 25% |
| Aetna | $234 | 25% |
| Providrs Care | $478 | 52% |
| Tricare | $623 | 67% |
| Humana | $867 - $876 | 94% |
| Medicare (plans) | $867 - $884 | 94% |
| Va | $867 | 94% |
| Smarthealth | $1,214 | 131% |
| Blue Cross Blue Shield | $1,249 - $1,315 | 135% |
| Ambetter / Centene | $1,474 | 159% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Ascension Via Christi Hospital Manhattan, Inc, the negotiated rates vary significantly depending on your insurance plan. While the lowest negotiated rate among participating payers is $225 (UnitedHealthcare), the highest is $1,474 (Ambetter / Centene). The median negotiated rate across all payers is $867, which is 90% of the Medicare benchmark amount of $926.63. This suggests that the facility's commercial rates are generally aligned with fair pricing standards rather than excessive markups. For patients with high-deductible plans, it is important to note that cash-pay rates can sometimes be lower than the insurance negotiated rate; however, since the cash median is not available in this dataset, patients should directly contact the hospital to inquire about self-pay or prompt-pay discounts before scheduling.
To ensure you are not overcharged, it is recommended to request a full itemized bill that lists every specific CPT code and service rendered, as summary bills often hide unbundled charges or services not received. Given that over 80% of hospital bills contain errors, verifying the line-by-line details is a critical step in reducing medical debt. Additionally, if you receive a balance bill for an out-of-network service at this in-network facility, you may be protected under the No Surprises Act, which prohibits providers from billing you for the difference between their chargemaster rate and your insurance allowed amount. Always dispute any surprise bills in writing and avoid signing consent waivers that waive your rights to review out-of-network costs for emergency or mandatory ancillary services.