CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Hospital Oklahoma City, Inc

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $875
Cash Discount Price: $3,530
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Oklahoma City, Inc is $875. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,530. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.94x the Medicare baseline. Located in 4300 West Memorial Road, Oklahoma City, OK.

Cash / Self-Pay

$3,530

Average discount available for prompt cash payment at this facility.

Insurance Median

$875

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: $3,530 (381%)

Insurance Median: $875 (94%)

Cash: $3,530 (381% of Medicare)

Ins. Median: $875 (94% 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
Longevity Health Plan [10477]	$50	5%
Blue Cross Blue Shield	$127 - $938	14%
Medicaid / KanCare	$297 - $1,204	32%
Tricare	$830 - $875	90%
Aetna	$875	94%
Champva [20065]	$875	94%
Cherokee Nation Health Serv Contracted [320066]	$875	94%
Cross Timbers Hospice [20098]	$875	94%
Dept Of Veteran Affairs Contracted [320106]	$875	94%
Elara Caring Aspire Hospice Contracted [320433]	$875	94%
Elara Caring Aspire Hospice [20433]	$875	94%
Halo Hcr Inc Hospice Contracted [320432]	$875	94%
Halo Hcr Inc Hospice [20432]	$875	94%
Humana	$875	94%
Indian Health Service Contracted [320198]	$875	94%
Kindful Hospice Contracted [320434]	$875	94%
Kindful Hospice [20434]	$875	94%
Medicare (plans)	$875 - $936	94%
Mercy Hospice Okc [20252]	$875	94%
Mercy Rehab Hospital Contracted [320260]	$875	94%
Provider Partners Health Plans Contracted [320450]	$875	94%
Qual Choice Contracted [320325]	$875	94%
UnitedHealthcare	$875	94%
Globalhealth Contracted [320145]	$893	96%
Cigna	$902	97%
Amg Spec Hosp Edmond [20034]	$936	101%
Ambetter / Centene	$1,204	130%
Home State Health Plan Contracted [320187]	$1,204	130%
Novasys Contracted [320285]	$1,204	130%
Community Care Contracted [320080]	$1,338	144%
Workers Comp [20426]	$1,511	163%
Health Choice Contracted [320166]	$1,688	182%
Healthsmart Preferred Care Contracted [320184]	$1,969	212%
Kempton Contracted [320214]	$1,969	212%

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 $3,530.
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 Oklahoma City, Inc 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.