CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Mercy Hospital Northwest Arkansas
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $844
- Cash Discount Price: $3,597
- vs. Medicare Baseline: 0.91x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Northwest Arkansas is $844. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,597. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.91x the Medicare baseline. Located in 2710 South Rife Medical Lane, Rogers, AR.
Cash / Self-Pay
$3,597
Average discount available for prompt cash payment at this facility.
Insurance Median
$844
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: $3,597 (388%)
Insurance Median: $844 (91%)
Cash: $3,597 (388% of Medicare)
Ins. Median: $844 (91% 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $119 - $1,033 | 13% |
| Indian Health Service Contracted [320198] | $119 | 13% |
| Indian Health Service [20198] | $119 | 13% |
| Arkansas Department Of Health [20036] | $297 | 32% |
| Medicaid / KanCare | $297 - $1,204 | 32% |
| Summit Community Care Contracted [320368] | $297 | 32% |
| Summit Community Care [20368] | $297 | 32% |
| Arkansas Total Care Contracted [320039] | $674 | 73% |
| Arkansas Total Care [20039] | $674 | 73% |
| Humana | $843 - $844 | 91% |
| Aetna | $844 | 91% |
| American Health Advantage Of Mo Mcr [20264] | $844 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $844 | 91% |
| Cigna | $844 | 91% |
| Cross Timbers Hospice [20098] | $844 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $844 | 91% |
| Elara Caring Aspire Hospice Contracted [320433] | $844 | 91% |
| Elara Caring Aspire Hospice [20433] | $844 | 91% |
| Globalhealth Contracted [320145] | $844 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $844 | 91% |
| Halo Hcr Inc Hospice [20432] | $844 | 91% |
| Independent Health [20197] | $844 | 91% |
| Jordan Valley Senior Care Pace [20515] | $844 | 91% |
| Kindful Hospice Contracted [320434] | $844 | 91% |
| Kindful Hospice [20434] | $844 | 91% |
| Medical Associates Health [20444] | $844 | 91% |
| Medicare (plans) | $844 - $878 | 91% |
| Mercy Hospice Okc [20252] | $844 | 91% |
| Pace Of The Ozarks [20518] | $844 | 91% |
| Provider Partners Health Plans Contracted [320450] | $844 | 91% |
| Qual Choice Contracted [320325] | $844 | 91% |
| Spina Bifida Hlthcare Benefit [20506] | $844 | 91% |
| Tribute Health Plan Mcr [20338] | $844 | 91% |
| Tricare | $844 | 91% |
| UnitedHealthcare | $844 | 91% |
| Valir Pace [20503] | $844 | 91% |
| Wellfirst Health Mcr [20443] | $844 | 91% |
| St Johns Mercy Rehab Llc Contracted [320359] | $946 | 102% |
| St Johns Mercy Rehab Llc [20359] | $946 | 102% |
| Usable Contracted [320409] | $1,033 | 111% |
| Ambetter / Centene | $1,204 | 130% |
| Home State Health Plan Contracted [320187] | $1,204 | 130% |
| Novasys Contracted [320285] | $1,204 | 130% |
| Aither Health Contracted [320449] | $1,560 | 168% |
| Edison Health Solutions Contracted [320502] | $1,560 | 168% |
| Mercy Benefit Admin Contracted [320251] | $1,560 | 168% |
| Yuzu Health Contracted [320521] | $1,560 | 168% |
| Health Choice Contracted [320166] | $1,594 | 172% |