Upper endoscopy with biopsy
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $876
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Via Christi Research | $867 | 94% |
| Humana | $867 | 94% |
| Saint Lukes Health Systems | $867 | 94% |
| Medicare (plans) | $867 - $884 | 94% |
| Vc Hope | $867 | 94% |
| Va | $867 | 94% |
| Blue Cross Blue Shield | $884 | 95% |
| UnitedHealthcare | $884 - $2,428 | 95% |
| Corizon | $1,084 | 117% |
| Smarthealth | $1,214 | 131% |
| Medicaid / KanCare | $1,474 | 159% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Via Christi Hospital Wichita St Teresa, Inc, the negotiated rates range from $867 to $2,428 depending on the insurance carrier. The lowest negotiated amount is $867, which aligns with the rates paid by several major payers including Via Christi Research, Humana, and Saint Lukes Health Systems. However, UnitedHealthcare negotiates a significantly higher rate, with amounts ranging up to $2,428, while Medicaid/KanCare pays $1,474. It is important to note that cash-pay rates are not available for this specific service, and the facility does not currently publish a median paid amount. Because cash prices are unavailable, patients with high-deductible plans should verify their specific plan's allowed amount, as commercial negotiated rates can sometimes exceed the theoretical cash price, making insurance coverage more cost-effective than paying out-of-pocket.
This facility is a voluntary non-profit church-owned acute care hospital located in Wichita, Kansas, and it holds a 4-star rating. The Medicare benchmark for this procedure is $926.63, which serves as the objective baseline for evaluating pricing markups. While the facility's median negotiated rate is $876.00, which is slightly below the Medicare benchmark, the wide variance in commercial payer rates highlights the importance of checking individual plan details before scheduling. Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, but they must ensure their provider is truly in-network to avoid unexpected costs. To minimize financial risk, patients are encouraged to request a full itemized billing audit before finalizing payment, as over 8