CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Mercy Hospital Springfield
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $838
- Cash Discount Price: $4,108
- vs. Medicare Baseline: 0.90x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Springfield is $838. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,108. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.90x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$4,108
Average discount available for prompt cash payment at this facility.
Insurance Median
$838
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: $4,108 (443%)
Insurance Median: $838 (90%)
Cash: $4,108 (443% of Medicare)
Ins. Median: $838 (90% 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.
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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 - $2,660 | 13% |
| Medicaid / KanCare | $250 - $799 | 27% |
| Evolutions Health Care Contracted [320124] | $421 | 45% |
| Federal Medical Center Contracted [320127] | $456 | 49% |
| Benefit Management Contracted [320052] | $471 | 51% |
| Health Systems Inc Contracted [320174] | $471 | 51% |
| Insurance System Inc Contracted [320465] | $471 | 51% |
| UnitedHealthcare | $799 - $1,671 | 86% |
| Mercy Benefit Admin Contracted [320251] | $804 - $937 | 87% |
| Point C Contracted [320238] | $831 - $1,219 | 90% |
| Aetna | $833 | 90% |
| Centurion Of Missouri [20459] | $833 | 90% |
| Champva [20065] | $833 | 90% |
| Cherokee Nation Health Serv Contracted [320066] | $833 | 90% |
| Cigna | $833 | 90% |
| Cross Timbers Hospice [20098] | $833 | 90% |
| Dept Of Veteran Affairs Contracted [320106] | $833 | 90% |
| Elara Caring Aspire Hospice [20433] | $833 | 90% |
| Globalhealth Contracted [320145] | $833 | 90% |
| Halo Hcr Inc Hospice Contracted [320432] | $833 | 90% |
| Halo Hcr Inc Hospice [20432] | $833 | 90% |
| Humana | $833 - $1,263 | 90% |
| Indian Health Service Contracted [320198] | $833 | 90% |
| Indian Health Service [20198] | $833 | 90% |
| Kindful Hospice Contracted [320434] | $833 | 90% |
| Kindful Hospice [20434] | $833 | 90% |
| Medicare (plans) | $833 - $876 | 90% |
| Mercy Hospice Okc [20252] | $833 | 90% |
| Mercy Mgd Behavioral Health Contracted [320259] | $833 | 90% |
| Mercy Rehab Hospital Contracted [320260] | $833 | 90% |
| Pace Of The Ozarks Contracted [320518] | $833 | 90% |
| Qual Choice Contracted [320325] | $833 | 90% |
| Tricare | $833 | 90% |
| Point C [20238] | $838 | 90% |
| 90 Degree Benefits Contracted [320436] | $858 | 93% |
| Show-Me Health Administrators Contracted [320483] | $858 - $899 | 93% |
| Aither Health Contracted [320449] | $894 | 96% |
| Auxiant Contracted [320462] | $894 | 96% |
| Ebms Contracted [320493] | $894 | 96% |
| Edison Health Solutions Contracted [320502] | $894 | 96% |
| Healthlink Contracted [320179] | $894 | 96% |
| Imagine 360 Contracted [320494] | $894 | 96% |
| Reflect Health Contracted [320492] | $894 | 96% |
| Yuzu Health Contracted [320521] | $894 | 96% |
| Provider Partners Health Plans Contracted [320450] | $918 | 99% |
| Healthscope Contracted [320182] | $1,061 | 115% |
| Centivo Contracted [320505] | $1,401 | 151% |
| Multiplan Contracted [320270] | $1,671 | 180% |
| Private Health Care Systems Contracted [320320] | $1,671 | 180% |
| Providrs Care Network Contracted [320484] | $1,734 | 187% |
| United Medical Resources Contracted [320454] | $2,307 | 249% |