Upper endoscopy with biopsy
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,812
- Cash Discount Price: $5,445
- vs. Medicare Baseline: 1.96x 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 |
|---|---|---|
| Indian Health Service Contracted [320198] | $124 | 13% |
| Blue Cross Blue Shield | $124 - $1,812 | 13% |
| Provider Partners Health Plans Contracted [320450] | $136 | 15% |
| Medicaid / KanCare | $250 - $1,812 | 27% |
| UnitedHealthcare | $799 - $1,812 | 86% |
| Show-Me Health Administrators Contracted [320483] | $899 | 97% |
| Mercy Benefit Admin Contracted [320251] | $899 | 97% |
| Health Choice Contracted [320166] | $1,594 | 172% |
| Humana | $1,689 - $1,847 | 182% |
| Aetna | $1,689 - $1,812 | 182% |
| Elara Caring Aspire Hospice [20433] | $1,812 | 196% |
| Kindful Hospice [20434] | $1,812 | 196% |
| Halo Hcr Inc Hospice [20432] | $1,812 | 196% |
| Cross Timbers Hospice [20098] | $1,812 | 196% |
| Cigna | $1,812 | 196% |
| Medicare (plans) | $1,812 | 196% |
| Pace Of The Ozarks Contracted [320518] | $1,812 | 196% |
| Tricare | $1,812 | 196% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,812 | 196% |
| Mercy Hospice Okc [20252] | $1,812 | 196% |
| Mercy Mgd Behavioral Health Contracted [320259] | $1,812 | 196% |
| Cherokee Nation Health Serv Contracted [320066] | $1,812 | 196% |
| Qual Choice Contracted [320325] | $1,812 | 196% |
| Globalhealth Contracted [320145] | $1,812 | 196% |
| Kindful Hospice Contracted [320434] | $1,812 | 196% |
| Medical Associates Health Contracted [320444] | $1,812 | 196% |
| Centivo Contracted [320505] | $1,847 | 199% |
| Dept Of Veteran Affairs Contracted [320106] | $1,847 | 199% |
| Health Systems Inc Contracted [320174] | $2,768 | 299% |
| Healthscope Contracted [320182] | $2,768 | 299% |
| Point C Contracted [320238] | $2,768 | 299% |
| Insurance System Inc Contracted [320465] | $2,768 | 299% |
| Benefit Management Contracted [320052] | $2,768 | 299% |
| United Medical Resources Contracted [320454] | $2,768 | 299% |
| Providrs Care Network Contracted [320484] | $3,509 | 379% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy (CPT 43239), the facility's cash median rate of $5,445 is significantly higher than the state average, which is reflected in the broad range of negotiated rates seen across payers. While many commercial plans, such as Blue Cross Blue Shield and Medicaid/KanCare, have negotiated rates as low as $124 to $1,812, these figures often represent the maximum allowed amount rather than the actual payment. It is important to note that cash-pay rates can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, though in this specific case, the cash rate is notably higher than the median negotiated rate of $1,812. Patients should verify their specific plan's allowed amount and consider asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
When reviewing your bill, be aware that commercial insurance rates are often inflated by administrative costs and contract dynamics, sometimes reaching 200% to 300% of the Medicare benchmark rate of $926.63 for this procedure. The No Surprises Act provides federal protection against balance billing for out-of-network providers at in-network facilities, meaning you should not pay surprise bills for emergency care or non-emergency services from out-of-network doctors or labs. If you receive a bill that seems excessive, request a formal itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes. Always compare your