CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Mercy Hospital Washington
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $871
- Cash Discount Price: $836
- vs. Medicare Baseline: 0.94x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Washington is $871. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $836. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.94x the Medicare baseline. Located in 901 East 5Th Street, Washington, MO.
Cash / Self-Pay
$836
Average discount available for prompt cash payment at this facility.
Insurance Median
$871
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: $836 (90%)
Insurance Median: $871 (94%)
Cash: $836 (90% of Medicare)
Ins. Median: $871 (94% 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 |
|---|---|---|
| Mercy Benefit Admin Contracted [320251] | $117 - $1,576 | 13% |
| Mercy Benefit Admin [20251] | $117 - $1,576 | 13% |
| Blue Cross Blue Shield | $124 - $2,125 | 13% |
| Cherokee Nation Health Serv Contracted [320066] | $124 - $871 | 13% |
| Cross Timbers Hospice [20098] | $124 - $871 | 13% |
| Elara Caring Aspire Hospice Contracted [320433] | $124 - $871 | 13% |
| Elara Caring Aspire Hospice [20433] | $124 - $871 | 13% |
| Halo Hcr Inc Hospice Contracted [320432] | $124 - $871 | 13% |
| Halo Hcr Inc Hospice [20432] | $124 - $871 | 13% |
| Indian Health Service Contracted [320198] | $124 | 13% |
| Kindful Hospice Contracted [320434] | $124 - $871 | 13% |
| Kindful Hospice [20434] | $124 - $871 | 13% |
| Mercy Hospice Okc [20252] | $124 - $871 | 13% |
| UnitedHealthcare | $124 - $871 | 13% |
| Tricare | $136 - $871 | 15% |
| Healthscope Contracted [320182] | $155 - $1,110 | 17% |
| Ambetter / Centene | $164 | 18% |
| Home State Health Plan Contracted [320187] | $164 | 18% |
| Medicaid / KanCare | $164 - $799 | 18% |
| Novasys Contracted [320285] | $164 | 18% |
| Centivo Contracted [320505] | $208 - $1,465 | 22% |
| Preferred Health Plan Contracted [320522] | $220 - $1,554 | 24% |
| United Medical Resources Contracted [320454] | $239 | 26% |
| Hope Trust Contracted [320488] | $283 - $888 | 31% |
| Aetna | $546 - $871 | 59% |
| Healthlink Contracted [320179] | $546 - $1,576 | 59% |
| Medical Associates Health Contracted [320444] | $656 - $772 | 71% |
| Federal Medical Center Contracted [320127] | $710 - $836 | 77% |
| Insurance System Inc Contracted [320465] | $710 - $836 | 77% |
| Point C Contracted [320238] | $710 - $836 | 77% |
| Tri State Healthcare Coalition Contracted [320379] | $710 - $836 | 77% |
| Cigna | $765 - $1,029 | 83% |
| First Health Contracted [320128] | $765 - $913 | 83% |
| Mercy Mgd Behavioral Health Contracted [320259] | $765 - $900 | 83% |
| Multiplan Contracted [320270] | $765 - $964 | 83% |
| Private Health Care Systems Contracted [320320] | $765 - $900 | 83% |
| Workers Comp [20426] | $820 - $1,029 | 88% |
| American Health Advantage Of Mo Mcr [10473] | $871 | 94% |
| Dept Of Veteran Affairs Contracted [320106] | $871 | 94% |
| Globalhealth Contracted [320145] | $871 | 94% |
| Humana | $871 | 94% |
| Medicare (plans) | $871 - $1,286 | 94% |
| Pace Of The Ozarks Contracted [320518] | $871 | 94% |
| Qual Choice Contracted [320325] | $871 | 94% |
| Provider Partners Health Plans Contracted [320450] | $960 | 104% |
| Medica Contracted [320239] | $1,135 | 122% |
| Show-Me Health Administrators Contracted [320483] | $1,530 - $1,607 | 165% |
| Aither Health Contracted [320449] | $1,576 | 170% |
| Aither Health [20449] | $1,576 | 170% |
| Auxiant Contracted [320462] | $1,576 | 170% |
| Ebms Contracted [320493] | $1,576 | 170% |
| Edison Health Solutions Contracted [320502] | $1,576 | 170% |
| Imagine 360 Contracted [320494] | $1,576 | 170% |
| Reflect Health Contracted [320492] | $1,576 | 170% |
| Yuzu Health Contracted [320521] | $1,576 | 170% |