Upper endoscopy with biopsy
Facility: Mercy Hospital Ardmore, Inc
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,896
- Cash Discount Price: $3,164
- vs. Medicare Baseline: 2.05x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 205% of the Medicare baseline (a markup of 105%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $127 - $1,897 | 14% |
| Workers Comp [20426] | $1,511 | 163% |
| Aetna | $1,689 - $1,896 | 182% |
| Humana | $1,689 - $1,933 | 182% |
| Medicaid / KanCare | $1,689 - $2,609 | 182% |
| Cherokee Nation Health Serv Contracted [320066] | $1,896 | 205% |
| Cross Timbers Hospice [20098] | $1,896 | 205% |
| Dept Of Veteran Affairs Contracted [320106] | $1,896 | 205% |
| Elara Caring Aspire Hospice Contracted [320433] | $1,896 | 205% |
| Elara Caring Aspire Hospice [20433] | $1,896 | 205% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,896 | 205% |
| Halo Hcr Inc Hospice [20432] | $1,896 | 205% |
| Independent Health [20197] | $1,896 | 205% |
| Indian Health Service Contracted [320198] | $1,896 | 205% |
| Kindful Hospice Contracted [320434] | $1,896 | 205% |
| Kindful Hospice [20434] | $1,896 | 205% |
| Medical Associates Health [20444] | $1,896 | 205% |
| Medicare (plans) | $1,896 - $2,010 | 205% |
| Mercy Hospice Okc [20252] | $1,896 | 205% |
| Provider Partners Health Plans Contracted [320450] | $1,896 | 205% |
| Qual Choice Contracted [320325] | $1,896 | 205% |
| Tribute Health Plan Mcr Contracted [320338] | $1,896 | 205% |
| Tricare | $1,896 | 205% |
| UnitedHealthcare | $1,933 | 209% |
| Globalhealth Contracted [320145] | $1,934 | 209% |
| Cigna | $1,954 - $3,261 | 211% |
| Ambetter / Centene | $2,609 | 282% |
| Home State Health Plan Contracted [320187] | $2,609 | 282% |
| Novasys Contracted [320285] | $2,609 | 282% |
| Community Care Contracted [320080] | $2,899 | 313% |
| Health Choice Contracted [320166] | $3,794 | 409% |
| Healthsmart Preferred Care Contracted [320184] | $4,266 | 460% |
| Kempton Contracted [320214] | $4,266 | 460% |