CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Missouri Baptist Sullivan Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,016
Cash Discount Price: $6,023
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Missouri Baptist Sullivan Hospital is $1,016. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,023. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.10x the Medicare baseline. Located in 751 Sappington Bridge Rd, Sullivan, MO.

Cash / Self-Pay

$6,023

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,016

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: $6,023 (650%)

Insurance Median: $1,016 (110%)

Cash: $6,023 (650% of Medicare)

Ins. Median: $1,016 (110% 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
Aetna	$279 - $559	30%
Essence Healthcare [221]	$279 - $559	30%
Humana	$282 - $1,688	30%
UnitedHealthcare	$284 - $2,823	31%
Cox Health [757]	$293 - $587	32%
Blue Cross Blue Shield	$296 - $2,209	32%
Medica [662]	$299 - $598	32%
Devoted Health Plan [847]	$307 - $613	33%
Cox Health Systems Insurance Company [220]	$698 - $1,396	75%
Health Alliance [224]	$698 - $1,396	75%
Allied Benefits [498]	$737 - $1,473	80%
Hope Trust [806]	$737 - $1,473	80%
Cigna	$790 - $1,744	85%
Healthscope Benefits [258]	$826 - $2,823	89%
Apwu Health Plan [216]	$872 - $1,744	94%
Nalc Health Benefit Plan [242]	$872 - $1,744	94%
Priority Health [648]	$872 - $1,744	94%
Healthcare Sol Mercy [609]	$952 - $1,904	103%
Med-Pay [480]	$952 - $1,904	103%
Medica [661]	$1,016 - $2,031	110%
Phcs [244]	$1,016 - $2,031	110%
Consociate [478]	$1,850 - $4,587	200%
Sarah Bush Lincoln [636]	$1,850 - $4,587	200%

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 $6,023.
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 Missouri Baptist Sullivan 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.