CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Merit Health Madison

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,572
Cash Discount Price: $832
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Merit Health Madison is $1,572. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $832. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.70x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$832

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,572

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: $832 (90%)

Insurance Median: $1,572 (170%)

Cash: $832 (90% of Medicare)

Ins. Median: $1,572 (170% 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
Advhealth	$521	56%
Blue Cross Blue Shield	$542	58%
Ms-Can-Molina	$736	79%
Ms-Can-Magnolia	$743	80%
Ms-Can-Truecare	$750	81%
Medicare (plans)	$819	88%
Wellcare	$843	91%
Humana	$852	92%
Devoted_Health	$860	93%
Molina-Chip	$1,572	170%
Mpcn	$1,598	172%
Magnolia-Chip	$1,608	174%
Truecare-Chip	$1,608	174%
Firstchoice	$1,638	177%
Molina_Exchange	$1,761	190%
Cigna	$1,998	216%
Ambetter / Centene	$2,080	224%
United	$2,080	224%
United_Exchange	$2,080	224%

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 $832.
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 Merit Health Madison 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.