CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Hospital Southeast

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $897
Cash Discount Price: $8,005
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercy Hospital Southeast is $897. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,005. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.97x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.

Cash / Self-Pay

$8,005

Average discount available for prompt cash payment at this facility.

Insurance Median

$897

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: $8,005 (864%)

Insurance Median: $897 (97%)

Cash: $8,005 (864% of Medicare)

Ins. Median: $897 (97% 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
Blue Cross Blue Shield	$124 - $5,199	13%
Indian Health Service Contracted [320198]	$124	13%
Imagine 360 Contracted [320494]	$592	64%
Medicaid / KanCare	$799	86%
UnitedHealthcare	$799 - $6,046	86%
Aetna	$880	95%
Cross Timbers Hospice [20098]	$880	95%
Dept Of Veteran Affairs Contracted [320106]	$880	95%
Elara Caring Aspire Hospice Contracted [320433]	$880	95%
Elara Caring Aspire Hospice [20433]	$880	95%
Halo Hcr Inc Hospice Contracted [320432]	$880	95%
Halo Hcr Inc Hospice [20432]	$880	95%
Humana	$880	95%
Kindful Hospice Contracted [320434]	$880	95%
Kindful Hospice [20434]	$880	95%
Medicare (plans)	$880 - $925	95%
Mercy Hospice Okc [20252]	$880	95%
Pace Of The Ozarks Contracted [320518]	$880	95%
Tricare	$880	95%
Ambetter / Centene	$897	97%
American Health Advantage Of Mo Mcr Hmo Contracted [320264]	$897	97%
Home State Health Plan Contracted [320187]	$897	97%
Hope Trust Contracted [320488]	$897	97%
Provider Partners Health Plans Contracted [320450]	$1,012	109%
Consociate Consolidated Health Contracted [320490]	$1,233 - $1,981	133%
Auxiant Contracted [320462]	$1,481 - $1,761	160%
Centivo Contracted [320505]	$1,481	160%
Ebms Contracted [320493]	$1,481	160%
Healthlink Contracted [320179]	$1,481 - $1,981	160%
Mercy Benefit Admin Contracted [320251]	$1,481	160%
Reflect Health Contracted [320492]	$1,535	166%
Preferred Health Plan Contracted [320522]	$1,571	170%
United Medical Resources Contracted [320454]	$6,046	652%
Cigna	$14,290	1542%

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 $8,005.
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 Southeast 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.