Upper endoscopy with biopsy
Facility: Rehabilitation Hospital Of Overland Park
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,878
- Cash Discount Price: $2,503
- vs. Medicare Baseline: 2.03x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $1,502 | 162% |
| Americas Choice Provider Network | $1,752 | 189% |
| Velocity | $1,878 | 203% |
| Usa Managed Care Organization | $1,878 | 203% |
| Provider Network Of America | $1,878 | 203% |
| Quiktrip Corporation | $1,878 | 203% |
| Multiplan-Phcs | $2,003 | 216% |
| Prime Health Services | $2,128 | 230% |
| Medincrease | $2,253 | 243% |
Consumer Guidance & Cost Commentary
For the Upper endoscopy with biopsy at the Rehabilitation Hospital Of Overland Park, the cash price is $2,503.00, which matches the facility's cash median. This rate is significantly higher than the state of Kansas average, indicated by a 2.0x multiplier relative to Medicare. While commercial insurance plans like Blue Cross Blue Shield and Prime Health Services negotiate rates ranging from $1,502 to $2,128, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying out-of-pocket can be more cost-effective, provided you confirm the facility offers a self-pay or prompt-pay discount before scheduling.
It is important to understand that commercial negotiated rates often include administrative costs for claims processing, which can inflate the baseline price by 20% to 40% compared to direct cash payments. If you choose to use insurance, be aware that the facility may bill you for the difference between the negotiated rate and what your plan allows, a practice known as balance billing, though the No Surprises Act protects you from such charges for emergency care and non-emergency services at in-network facilities. To ensure you are not overcharged, always request a full itemized bill before paying and verify that no services were unbundled or double-billed, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.