CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $720
Cash Discount Price: $1,547
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Medical Center is $720. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,547. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.78x the Medicare baseline. Located in 1320 Mercy Drive Nw, Canton, OH.

Cash / Self-Pay

$1,547

Average discount available for prompt cash payment at this facility.

Insurance Median

$720

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: $1,547 (167%)

Insurance Median: $720 (78%)

Cash: $1,547 (167% of Medicare)

Ins. Median: $720 (78% 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
Summacare	$84 - $1,239	9%
Aetna	$129 - $4,001	14%
Blue Cross Blue Shield	$129 - $2,393	14%
Cigna	$129 - $1,944	14%
Humana	$129 - $866	14%
The Health Plan	$129 - $3,732	14%
United	$129 - $4,338	14%
Mmo	$133 - $1,715	14%
Communicare	$135 - $910	15%
Oscar	$136 - $1,435	15%
Perennial Health	$139 - $936	15%
Zing Health	$142 - $953	15%
Caresource	$144 - $650	16%
Buckeye	$147 - $650	16%
Aultcare	$148 - $1,530	16%
Amerihealth	$154 - $694	17%
Molina	$154 - $663	17%
Ohcp	$198 - $1,814	21%
Omas	$254 - $1,866	27%
Phphi	$305 - $2,239	33%
Gms	$356 - $2,612	38%
Immergrun	$381 - $1,866	41%
Multiplan	$457 - $3,359	49%
Cc Ehp	$1,489 - $1,511	161%
Amish Community Aid Plan	$1,679 - $1,866	181%
Ohio Healthy	$2,015	217%
Php	$2,239	242%
Medical Benefit Corp	$2,612	282%
Consociate Health	$2,799	302%
Frontpath	$3,359	362%
Managed Care Services	$3,359	362%
Tertiary Care Network	$3,359	362%

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 $1,547.
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 Medical Center 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.