CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The Children's Mercy Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $663
Cash Discount Price: $906
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at The Children's Mercy Hospital is $663. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $906. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.72x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$906

Average discount available for prompt cash payment at this facility.

Insurance Median

$663

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)

Cash / Self-Pay: $906 (98%)

Insurance Median: $663 (72%)

Cash: $906 (98% of Medicare)

Ins. Median: $663 (72% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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 - $2,250	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%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $906.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.