Upper endoscopy with biopsy
Facility: Mercy Hospital Fort Smith
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $857
- Cash Discount Price: $4,095
- vs. Medicare Baseline: 0.92x 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 |
|---|---|---|
| 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 - $1,224 | 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 | $844 - $857 | 91% |
| Aetna | $857 | 92% |
| American Health Advantage Of Mo Mcr [20264] | $857 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $857 | 92% |
| Cross Timbers Hospice [20098] | $857 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $857 | 92% |
| Elara Caring Aspire Hospice Contracted [320433] | $857 | 92% |
| Elara Caring Aspire Hospice [20433] | $857 | 92% |
| Globalhealth Contracted [320145] | $857 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $857 | 92% |
| Halo Hcr Inc Hospice [20432] | $857 | 92% |
| Independent Health [20197] | $857 | 92% |
| Jordan Valley Senior Care Pace [20515] | $857 | 92% |
| Kindful Hospice Contracted [320434] | $857 | 92% |
| Kindful Hospice [20434] | $857 | 92% |
| Medical Associates Health [20444] | $857 | 92% |
| Medicare (plans) | $857 - $901 | 92% |
| Mercy Hospice Okc [20252] | $857 | 92% |
| Pace Of The Ozarks [20518] | $857 | 92% |
| Provider Partners Health Plans Contracted [320450] | $857 | 92% |
| Qual Choice Contracted [320325] | $857 | 92% |
| Spina Bifida Hlthcare Benefit [20506] | $857 | 92% |
| Tribute Health Plan Mcr [20338] | $857 | 92% |
| Tricare | $857 | 92% |
| UnitedHealthcare | $857 - $874 | 92% |
| Valir Pace [20503] | $857 | 92% |
| Wellfirst Health Mcr [20443] | $857 | 92% |
| Cigna | $901 | 97% |
| Usable Contracted [320409] | $1,033 | 111% |
| Ambetter / Centene | $1,224 | 132% |
| Home State Health Plan Contracted [320187] | $1,224 | 132% |
| Novasys Contracted [320285] | $1,224 | 132% |
| Aither Health Contracted [320449] | $1,268 | 137% |
| Edison Health Solutions Contracted [320502] | $1,268 | 137% |
| Mercy Benefit Admin Contracted [320251] | $1,268 | 137% |
| Health Choice Contracted [320166] | $1,594 | 172% |