Upper endoscopy with biopsy
Facility: Menorah Medical Center
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 |
|---|---|---|
| Amerigroup | $294 | 32% |
| United | $294 - $3,331 | 32% |
| Healthyblue | $300 | 32% |
| Medicaid / KanCare | $302 | 33% |
| Unicare | $305 | 33% |
| Aetna | $305 - $2,417 | 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 Menorah Medical Center in Overland Park, KS, the facility's negotiated rates range from $294 to $4,562 depending on the insurance plan. The lowest negotiated rate found is $294 with Amerigroup, while the highest is $4,562 with Multiplan. The median negotiated rate across all payers is $1,770. This facility is an Acute Care Hospital with a Proprietary ownership structure and is located in zip code 66209. While specific cash or median paid values were not reported for this code, patients should note that cash-pay options can sometimes be more cost-effective than insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount exceeds the cash price. It is always recommended to ask the hospital directly about self-pay or prompt-pay discounts before scheduling to potentially lower out-of-pocket costs.
The Medicare benchmark for this service is $926.63, which serves as a baseline for evaluating pricing fairness. Commercial negotiated rates often exceed this benchmark due to administrative costs and contract dynamics, with fair pricing typically defined as 120% to 150% of the Medicare rate. In this case, the median negotiated rate of $1,770 is approximately 1.9 times the Medicare amount. Patients should be aware of balance billing risks if they receive care from out-of-network providers, though the No Surprises Act protects against such billing for emergency and non-emergency services at in-network facilities. To ensure accuracy, consumers should request a full itemized bill rather than accepting a summary invoice, as over 8