CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Barnes Jewish Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,922
Cash Discount Price: $3,771
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Barnes Jewish Hospital is $1,922. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,771. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.07x the Medicare baseline. Located in One Barnes-Jewish Hospital Plaza, Saint Louis, MO.

Cash / Self-Pay

$3,771

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,922

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: $3,771 (407%)

Insurance Median: $1,922 (207%)

Cash: $3,771 (407% of Medicare)

Ins. Median: $1,922 (207% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 207% of the Medicare baseline (a markup of 107%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Healthscope Benefits [258]	$470 - $2,643	51%
UnitedHealthcare	$470 - $2,643	51%
Blue Cross Blue Shield	$574 - $3,424	62%
Cox Health Systems Insurance Company [220]	$574 - $1,148	62%
Health Alliance [224]	$574 - $1,148	62%
Allied Benefits [498]	$606 - $3,209	65%
Hope Trust [806]	$606 - $1,211	65%
Healthcare Sol Mercy [609]	$783 - $1,566	84%
Med-Pay [480]	$783 - $1,566	84%
Medica [661]	$835 - $1,670	90%
Phcs [244]	$835 - $1,670	90%
Aetna	$908 - $3,209	98%
Essence Healthcare [221]	$908 - $1,922	98%
Humana	$908 - $8,188	98%
Cox Health [757]	$954 - $2,018	103%
Devoted Health Plan [847]	$954 - $2,018	103%
Medica [662]	$954 - $2,018	103%
Cigna	$2,621 - $9,994	283%
Consociate [478]	$2,740 - $5,505	296%
Sarah Bush Lincoln [636]	$2,740 - $5,505	296%
Coresource [497]	$3,209	346%
Fmh Benefit Service Inc [222]	$3,209	346%
Mail Handlers [495]	$3,209	346%
Apwu Health Plan [216]	$4,641 - $9,994	501%
Nalc Health Benefit Plan [242]	$4,641 - $9,994	501%
Priority Health [648]	$4,641 - $9,994	501%

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 $3,771.
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 Barnes Jewish Hospital 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.