Upper endoscopy with biopsy
Facility: Overland Park Reg Med Ctr
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,770
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.91x 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 |
|---|---|---|
| United | $294 - $3,181 | 32% |
| Amerigroup | $294 | 32% |
| Healthyblue | $300 | 32% |
| Medicaid / KanCare | $302 | 33% |
| Aetna | $305 - $2,417 | 33% |
| Unicare | $305 | 33% |
| Home State Health Plan | $839 | 91% |
| Multiplan | $1,190 - $4,562 | 128% |
| Corvel Corporation | $1,413 | 152% |
| Oha Network | $1,472 | 159% |
| Humana | $1,770 - $2,192 | 191% |
| Universal Healthcare | $1,995 | 215% |
| Cigna | $2,460 - $3,668 | 265% |
| Nhc Advantage | $2,550 | 275% |
| Oscar | $3,122 | 337% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Overland Park Reg Med Ctr, the facility's negotiated rates range from $294 to $4,562 depending on the insurance carrier. The lowest negotiated rate of $294 is significantly lower than the facility's median negotiated rate of $1,770, while the highest rate of $4,562 from Multiplan exceeds the median. When compared to the Medicare benchmark of $926.63, the facility's average negotiated rate is 1.9 times higher, indicating a substantial markup above the federal baseline. This variation highlights that in-network status does not guarantee the lowest price, as different insurers contract for vastly different amounts.
Patients should be aware that cash-pay options may offer savings if the insurance negotiated rate exceeds the cash price, though cash rates are not listed for this specific service. To potentially reduce costs, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% for upfront payments. Additionally, since over 80% of hospital bills contain errors, it is advisable to request a detailed, itemized bill before agreeing to pay, ensuring that all charges are accurate and that no services were rendered or bundled incorrectly.