CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Hospital Lebanon

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,805
Cash Discount Price: $4,442
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Lebanon is $1,805. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,442. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.95x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.

Cash / Self-Pay

$4,442

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,805

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: $4,442 (479%)

Insurance Median: $1,805 (195%)

Cash: $4,442 (479% of Medicare)

Ins. Median: $1,805 (195% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$124 - $5,736	13%
Indian Health Service Contracted [320198]	$124	13%
Medicaid / KanCare	$294 - $1,689	32%
Health Systems Inc Contracted [320174]	$421	45%
Insurance System Inc Contracted [320465]	$421	45%
Point C Contracted [320238]	$760	82%
Point C [20238]	$760	82%
UnitedHealthcare	$799 - $1,805	86%
Medicare (plans)	$1,737 - $1,840	187%
Aetna	$1,805	195%
Champva [20065]	$1,805	195%
Cherokee Nation Health Serv Contracted [320066]	$1,805	195%
Cigna	$1,805	195%
Cross Timbers Hospice [20098]	$1,805	195%
Dept Of Veteran Affairs Contracted [320106]	$1,805	195%
Elara Caring Aspire Hospice [20433]	$1,805	195%
Globalhealth Contracted [320145]	$1,805	195%
Halo Hcr Inc Hospice Contracted [320432]	$1,805	195%
Halo Hcr Inc Hospice [20432]	$1,805	195%
Humana	$1,805	195%
Kindful Hospice Contracted [320434]	$1,805	195%
Kindful Hospice [20434]	$1,805	195%
Mercy Hospice Okc [20252]	$1,805	195%
Mercy Mgd Behavioral Health Contracted [320259]	$1,805	195%
Pace Of The Ozarks Contracted [320518]	$1,805	195%
Provider Partners Health Plans Contracted [320450]	$1,805	195%
Qual Choice Contracted [320325]	$1,805	195%
Tricare	$1,805	195%
Healthscope Contracted [320182]	$2,300	248%
Centivo Contracted [320505]	$3,036	328%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $4,442.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Lebanon is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.