Upper endoscopy with biopsy
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $895
- Cash Discount Price: $7,339
- vs. Medicare Baseline: 0.97x 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 | $122 - $1,411 | 13% |
| Indian Health Service Contracted [320198] | $122 | 13% |
| Medicaid / KanCare | $294 - $913 | 32% |
| UnitedHealthcare | $799 - $913 | 86% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $895 | 97% |
| Halo Hcr Inc Hospice [20432] | $895 | 97% |
| Mercy Hospice Okc [20252] | $895 | 97% |
| Elara Caring Aspire Hospice [20433] | $895 | 97% |
| Halo Hcr Inc Hospice Contracted [320432] | $895 | 97% |
| Humana | $895 | 97% |
| Kindful Hospice [20434] | $895 | 97% |
| Medicare (plans) | $895 - $932 | 97% |
| Kindful Hospice Contracted [320434] | $895 | 97% |
| Tricare | $895 | 97% |
| Dept Of Veteran Affairs Contracted [320106] | $895 | 97% |
| Pace Of The Ozarks Contracted [320518] | $895 | 97% |
| Cross Timbers Hospice [20098] | $895 | 97% |
| Aetna | $895 | 97% |
| Ambetter / Centene | $913 | 99% |
| Home State Health Plan Contracted [320187] | $913 | 99% |
| Providrs Care Network Contracted [320484] | $1,734 | 187% |
| Health Choice Contracted [320166] | $1,875 | 202% |
Consumer Guidance & Cost Commentary
For the procedure "Upper endoscopy with biopsy" at Mercy Hospital Pittsburg, Inc., the facility's cash price of $7,339 is significantly higher than the state average for this service, which is $892. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $122 to $1,411, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the $7,339 cash price is lower than the negotiated ceilings many insurers apply. It is crucial to verify the specific allowed amount for your plan before scheduling, as in-network rates vary widely even within the same facility.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before check-in, which can reduce the final bill by 20% to 50% by bypassing insurance billing cycles and administrative fees. Additionally, since the facility's Medicare benchmark for this code is $926.63, the cash price represents a substantial markup compared to the federal baseline, highlighting the importance of comparing rates against the Medicare amount rather than the hospital's full chargemaster list. If you receive a bill after using insurance, you should request a detailed itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected to lower your debt.