Upper endoscopy with biopsy
Facility: Ascension Via Christi Rehabilitation Hospital 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 |
|---|---|---|
| Aetna | $649 | 70% |
| Medicare (plans) | $867 - $884 | 94% |
| Va | $867 | 94% |
| Vc Hope | $867 | 94% |
| Humana | $867 | 94% |
| Blue Cross Blue Shield | $884 | 95% |
| UnitedHealthcare | $884 - $2,428 | 95% |
| Smarthealth | $1,214 | 131% |
| Medicaid / KanCare | $1,474 | 159% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Ascension Via Christi Rehabilitation Hospital Inc in Wichita, KS, the facility's negotiated rates range from $649 to $2,428 depending on the insurance plan. The lowest negotiated rate of $649 is significantly lower than the state average, while the highest rate of $2,428 is notably higher. The median negotiated rate across all payers is $876, which is slightly lower than the state average. Medicare serves as a reliable benchmark for pricing transparency; the facility's Medicare amount of $926.63 indicates that commercial negotiated rates can vary widely, with some plans paying less and others paying substantially more than the federal baseline.
Patients should be aware that cash-pay options may offer savings if their insurance negotiated rate exceeds the cash price, though cash rates were not reported for this specific code. To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payments. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should always request a detailed, itemized bill to verify that all charges align with the negotiated rates and that no unbundled codes or services not rendered have been included.