CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Mary's Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $949
Cash Discount Price: $903
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Mary's Medical Center is $949. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $903. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.02x the Medicare baseline. Located in 201 Nw R D Mize Rd, Blue Springs, MO.

Cash / Self-Pay

$903

Average discount available for prompt cash payment at this facility.

Insurance Median

$949

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: $903 (97%)

Insurance Median: $949 (102%)

Cash: $903 (97% of Medicare)

Ins. Median: $949 (102% 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
Medicaid / KanCare	$799	86%
Blue Cross Blue Shield	$898 - $1,672	97%
Aetna	$904 - $2,488	98%
Cigna	$904	98%
Home State	$904 - $1,446	98%
Medicare (plans)	$904 - $949	98%
Tricare	$904	98%
UnitedHealthcare	$904 - $3,006	98%
Veterans Evaluation Services	$904	98%
Kansas Superior	$922	100%
Healthy Blue	$949 - $1,143	102%
Employer Direct Healthcare	$1,266	137%
6 Degrees	$1,808	195%

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 $903.
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 St Mary's Medical Center 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.