CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Hospital South

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,153

about 1.2× the $927 Medicare rate · typically $648–$1,831

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,711

Above the fair price

about $558 over the fair price · 1.8× Medicare

Medicare pays $927 Fair price $1,153 This hospital $1,711 Cash price $3,698 Hospital's list price $5,689

How we calculate the fair BaseRate →

How this hospital compares to other MO hospitals

Highest price of the 9 MO hospitals we have prices for — worth calling around.

Cheapest $118 Priciest $1,711

Black dot = this hospital, among the 9 MO hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,153 (about 1.2× the $927 Medicare rate). Mercy Hospital South charges insurers about $1,711, or about $3,698 in cash — above the fair price. Located in Saint Louis, MO.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $1,153. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$799 - $1,763	86%
Blue Cross Blue Shieldmajor	$128 - $1,806	14%
Aetnamajor	$1,763	190%
Cignamajor	$1,798	194%
Humanamajor	$1,763	190%
HealthLink	$1,711	185%
Medica	$1,135	122%
+ 28 smaller / regional plans	$128 - $2,965

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,698), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Hospital South is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Hospital South

Compare: Upper endoscopy with biopsy at other MO hospitals

Insurance negotiated median for the same procedure, sorted lowest first.