CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Mercy St Francis Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $520
- Cash Discount Price: $2,323
- vs. Medicare Baseline: 0.56x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy St Francis Hospital is $520. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,323. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.56x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.
Cash / Self-Pay
$2,323
Average discount available for prompt cash payment at this facility.
Insurance Median
$520
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: $2,323 (251%)
Insurance Median: $520 (56%)
Cash: $2,323 (251% of Medicare)
Ins. Median: $520 (56% 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 |
|---|---|---|
| Centivo Contracted [320505] | $139 | 15% |
| Medicare (plans) | $158 - $876 | 17% |
| Blue Cross Blue Shield | $165 - $1,150 | 18% |
| Cigna | $165 - $254 | 18% |
| Globalhealth Contracted [320145] | $165 | 18% |
| Humana | $165 - $969 | 18% |
| Medical Associates Health Contracted [320444] | $165 | 18% |
| Pace Of The Ozarks Contracted [320518] | $165 | 18% |
| Point C Contracted [320238] | $165 - $1,023 | 18% |
| Provider Partners Health Plans Contracted [320450] | $165 | 18% |
| Qual Choice Contracted [320325] | $165 | 18% |
| Healthlink Contracted [320179] | $185 - $1,023 | 20% |
| Ambetter / Centene | $195 | 21% |
| Home State Health Plan Contracted [320187] | $195 | 21% |
| Medicaid / KanCare | $195 - $799 | 21% |
| Novasys Contracted [320285] | $195 | 21% |
| Aetna | $214 - $369 | 23% |
| United Medical Resources Contracted [320454] | $303 - $969 | 33% |
| UnitedHealthcare | $303 - $1,023 | 33% |
| Tricare | $366 | 39% |
| Cherokee Nation Health Serv Contracted [320066] | $369 | 40% |
| Cross Timbers Hospice [20098] | $369 | 40% |
| Dept Of Veteran Affairs Contracted [320106] | $369 | 40% |
| Elara Caring Aspire Hospice [20433] | $369 | 40% |
| Halo Hcr Inc Hospice Contracted [320432] | $369 | 40% |
| Halo Hcr Inc Hospice [20432] | $369 | 40% |
| Indian Health Service Contracted [320198] | $369 | 40% |
| Kindful Hospice Contracted [320434] | $369 | 40% |
| Kindful Hospice [20434] | $369 | 40% |
| Mercy Hospice Okc [20252] | $369 | 40% |
| Mercy Mgd Behavioral Health Contracted [320259] | $369 | 40% |
| Administrative Payor Contracted [320005] | $485 | 52% |
| Healthscope Contracted [320182] | $491 | 53% |
| Multiplan Contracted [320270] | $520 - $1,000 | 56% |
| Private Health Care Systems Contracted [320320] | $520 - $1,000 | 56% |
| Preferred Health Plan Contracted [320522] | $700 | 76% |
| Workers Comp [20426] | $862 - $915 | 93% |
| Auxiant Contracted [320462] | $969 - $1,023 | 105% |
| Mercy Benefit Admin Contracted [320251] | $969 - $1,023 | 105% |
| Aither Health Contracted [320449] | $1,023 | 110% |
| Benefit Management Contracted [320052] | $1,023 | 110% |
| Ebms Contracted [320493] | $1,023 | 110% |
| Edison Health Solutions Contracted [320502] | $1,023 | 110% |
| Evolutions Health Care Contracted [320124] | $1,023 | 110% |
| First Health Contracted [320128] | $1,023 | 110% |
| Health Systems Inc Contracted [320174] | $1,023 | 110% |
| Imagine 360 Contracted [320494] | $1,023 | 110% |
| Insurance System Inc Contracted [320465] | $1,023 | 110% |
| Point C [20238] | $1,023 | 110% |
| Reflect Health Contracted [320492] | $1,023 | 110% |
| Show-Me Health Administrators Contracted [320483] | $1,023 | 110% |
| Usa Managed Care Org Contracted [320429] | $1,023 | 110% |
| Yuzu Health Contracted [320521] | $1,023 | 110% |