Upper endoscopy with biopsy
Facility: Kansas Heart Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $909
- Cash Discount Price: $799
- vs. Medicare Baseline: 0.98x 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 |
|---|---|---|
| Wppa - All Plans | $507 | 55% |
| Blue Cross Blue Shield | $742 - $1,268 | 80% |
| Tricare | $752 | 81% |
| UnitedHealthcare | $836 - $1,268 | 90% |
| Celtic Mcr Adv | $836 | 90% |
| Medicaid / KanCare | $836 - $1,268 | 90% |
| Humana | $836 | 90% |
| Multiplan - All Plans | $1,141 | 123% |
| Aetna | $1,236 - $1,268 | 133% |
| Celtic Mcaid - All Other Plans | $1,268 | 137% |
| Soonerselect Mcaid - All Plans | $1,268 | 137% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at Kansas Heart Hospital in Wichita, KS, the cash median price is $799.00, which is lower than the facility's negotiated rates for most payers. While the facility's cash rate is significantly below the gross charge of $1,268.00, patients with high-deductible plans may find that paying cash directly is more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash price. For instance, UnitedHealthcare and Medicaid/KanCare have negotiated ranges that reach up to the gross amount, whereas the cash option remains fixed at $799.00. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
The facility's pricing is benchmarked against the Medicare rate of $926.63, which serves as a scientifically validated baseline for the true cost of care. The cash median of $799.00 is approximately 15% below the Medicare amount, indicating a competitive pricing structure relative to federal standards. Although the facility is a Proprietary Acute Care Hospital with a 4-star rating, patients should be aware that commercial negotiated rates often include administrative overhead that inflates the baseline price. It is crucial to avoid accepting summary bills as final invoices; instead, patients should request a detailed, itemized CPT-coded statement to identify any unbundled charges or services not rendered, ensuring transparency before payment.