Upper endoscopy with biopsy
Facility: Providence Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $897
- Cash Discount Price: $854
- vs. Medicare Baseline: 0.97x 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 - $2,665 | 32% |
| Medicaid / KanCare | $294 | 32% |
| Celtic | $300 - $1,367 | 32% |
| Healthy Blue | $300 - $897 | 32% |
| Aetna | $300 - $2,488 | 32% |
| Comp Alliance - Fka Compresults Worker Compensation | $674 | 73% |
| Cigna | $854 | 92% |
| Medicare (plans) | $854 | 92% |
| Tricare | $854 | 92% |
| Midland Care Connection | $854 | 92% |
| Kansas Superior Select | $897 | 97% |
| Corizon | $1,111 | 120% |
| Well Path Prison | $1,196 | 129% |
| Employer Direct Healthcare | $1,196 | 129% |
| Centurion | $1,282 | 138% |
| Naphcare | $1,324 | 143% |
| Blue Cross Blue Shield | $1,367 - $1,581 | 148% |
| Oha Networks | $1,442 | 156% |
| Worker Compensation | $1,487 | 160% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Providence Medical Center in Kansas City, KS, the cash price is $854.00, which matches the facility's cash median. This rate is significantly lower than the negotiated rates paid by most major payers, such as UnitedHealthcare, Aetna, and Blue Cross Blue Shield, which range from $854 to $2,665 depending on the specific plan. While the facility's cash price is competitive, patients should be aware that many insurance plans pay negotiated rates that exceed this cash amount; however, if a patient has a high-deductible plan, paying the cash price upfront may result in lower out-of-pocket costs compared to the insurance allowed amount, provided the patient's deductible has not been met.
To ensure you are not overcharged, it is recommended 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, patients should explicitly ask about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims. Since the facility is a voluntary non-profit, these discounts may be more readily available than at for-profit competitors, but verifying the exact discount terms with the billing department prior to scheduling is essential to avoid balance billing or unexpected fees.