Upper endoscopy with biopsy
Facility: Children'S Mercy South
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $663
- Cash Discount Price: $906
- vs. Medicare Baseline: 0.72x 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 |
|---|---|---|
| Healthlink | $170 - $2,622 | 18% |
| Health Midwest Comprehensive Care | $183 - $1,939 | 20% |
| American Healthcare Alliance | $194 - $2,532 | 21% |
| Quiktrip | $229 - $1,939 | 25% |
| Wellfit/Centrus | $253 - $1,936 | 27% |
| Centivo | $260 - $1,936 | 28% |
| Nebraska Furniture Mart | $262 - $1,936 | 28% |
| Humana | $277 - $1,981 | 30% |
| Orscheln | $280 - $1,936 | 30% |
| Multiplan | $284 - $2,264 | 31% |
| Blue Cross Blue Shield | $289 - $2,204 | 31% |
| Aetna | $292 - $2,026 | 32% |
| UnitedHealthcare | $299 - $2,002 | 32% |
| Healthy Blue | $319 - $2,250 | 34% |
| Medicaid / KanCare | $322 - $344 | 35% |
| Cigna | $353 - $2,070 | 38% |
| Coventry Health Care Of Kansas | $369 - $2,204 | 40% |
| Home State Health | $369 - $1,977 | 40% |
| Wppa Providrs Care | $461 - $1,936 | 50% |
| Medica | $463 - $1,737 | 50% |
| Mercy Health | $580 - $2,234 | 63% |
| Coxhealth Network | $588 - $2,204 | 63% |
| National Preferred Provider Network | $700 - $2,681 | 76% |
Consumer Guidance & Cost Commentary
For an upper endoscopy with biopsy at Children's Mercy South in Overland Park, KS, the facility's cash price of $906.00 is significantly lower than the gross chargemaster rate of $1,887.00 and the Medicare benchmark of $926.63. While the facility's negotiated rates with major insurers like Blue Cross Blue Shield and Aetna range from $289 to $2,026, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can bypass administrative fees and reduce the final cost.
The data indicates that the facility's cash rate is competitive relative to the broader market, though the wide variance in negotiated rates across 23 different payers highlights the importance of checking individual plan allowances. For instance, Medicaid/KanCare plans have a negotiated range of $322 to $344, which is notably lower than the cash price, while some commercial plans like National Preferred Provider Network have negotiated rates starting at $700. Patients should avoid accepting summary bills without requesting a detailed, itemized statement to ensure no unbundled codes or services not rendered are included, and they should dispute any unexpected charges in writing rather than paying immediately to protect their rights. Ultimately, comparing the facility's rates against the Medicare benchmark provides a clear view of the true cost, revealing that the cash price