CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Mercy Hospital Waldron
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $263
- Cash Discount Price: $623
- vs. Medicare Baseline: 0.28x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Waldron is $263. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $623. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.28x the Medicare baseline. Located in 1341 West Sixth Street, Waldron, AR.
Cash / Self-Pay
$623
Average discount available for prompt cash payment at this facility.
Insurance Median
$263
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: $623 (67%)
Insurance Median: $263 (28%)
Cash: $623 (67% of Medicare)
Ins. Median: $263 (28% 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 |
|---|---|---|
| Medicare (plans) | $135 - $271 | 15% |
| Aetna | $153 - $623 | 17% |
| American Health Advantage Of Mo Mcr [20264] | $153 | 17% |
| Blue Cross Blue Shield | $153 - $862 | 17% |
| Cigna | $153 - $814 | 17% |
| Dept Of Veteran Affairs Contracted [320106] | $153 | 17% |
| Globalhealth Contracted [320145] | $153 | 17% |
| Humana | $153 - $814 | 17% |
| Independent Health [20197] | $153 | 17% |
| Jordan Valley Senior Care Pace [20515] | $153 | 17% |
| Medical Associates Health [20444] | $153 | 17% |
| Pace Of The Ozarks [20518] | $153 | 17% |
| Provider Partners Health Plans Contracted [320450] | $153 | 17% |
| Qual Choice Contracted [320325] | $153 | 17% |
| UnitedHealthcare | $153 - $263 | 17% |
| Valir Pace [20503] | $153 | 17% |
| Ambetter / Centene | $236 | 25% |
| Home State Health Plan Contracted [320187] | $236 | 25% |
| Medicaid / KanCare | $236 - $321 | 25% |
| Novasys Contracted [320285] | $236 - $671 | 25% |
| Qual Choice Contracted [320324] | $236 | 25% |
| Tricare | $259 | 28% |
| Cherokee Nation Health Serv Contracted [320066] | $263 | 28% |
| Cross Timbers Hospice [20098] | $263 | 28% |
| Elara Caring Aspire Hospice Contracted [320433] | $263 | 28% |
| Elara Caring Aspire Hospice [20433] | $263 | 28% |
| Halo Hcr Inc Hospice Contracted [320432] | $263 | 28% |
| Halo Hcr Inc Hospice [20432] | $263 | 28% |
| Indian Health Service Contracted [320198] | $263 | 28% |
| Indian Health Service [20198] | $263 | 28% |
| Kindful Hospice Contracted [320434] | $263 | 28% |
| Kindful Hospice [20434] | $263 | 28% |
| Mercy Hospice Okc [20252] | $263 | 28% |
| Spina Bifida Hlthcare Benefit [20506] | $263 | 28% |
| Mercy Interfacility [20513] | $426 | 46% |
| Auxiant Contracted [320462] | $575 | 62% |
| Mercy Benefit Admin Contracted [320251] | $575 - $814 | 62% |
| Workers Comp [20426] | $623 | 67% |
| 90 Degree Benefits Contracted [320436] | $814 | 88% |
| Aither Health Contracted [320449] | $814 | 88% |
| Ebms Contracted [320493] | $814 | 88% |
| Edison Health Solutions Contracted [320502] | $814 | 88% |
| Healthlink Contracted [320179] | $814 | 88% |
| Imagine 360 Contracted [320494] | $814 | 88% |
| Multiplan Contracted [320270] | $814 | 88% |
| Multiplan [20270] | $814 | 88% |
| Municipal Health Plan Contracted [320271] | $814 | 88% |
| Reflect Health Contracted [320492] | $814 | 88% |
| Show-Me Health Administrators Contracted [320483] | $814 | 88% |
| Usable Contracted [320409] | $862 | 93% |
| Health Choice Contracted [320166] | $1,875 | 202% |