CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Louis Childrens Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,850
Cash Discount Price: $8,732
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Louis Childrens Hospital is $1,850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,732. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.00x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$8,732

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,850

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: $8,732 (942%)

Insurance Median: $1,850 (200%)

Cash: $8,732 (942% of Medicare)

Ins. Median: $1,850 (200% 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
Cigna	$839 - $1,852	91%
Aetna	$893 - $3,669	96%
Blue Cross Blue Shield	$893 - $3,669	96%
Essence Healthcare [221]	$893 - $3,669	96%
Humana	$893 - $3,669	96%
UnitedHealthcare	$893 - $6,278	96%
Consociate [478]	$924 - $1,848	100%
Sarah Bush Lincoln [636]	$924 - $1,848	100%
Apwu Health Plan [216]	$926 - $1,852	100%
Nalc Health Benefit Plan [242]	$926 - $1,852	100%
Priority Health [648]	$926 - $1,852	100%
Cox Health [757]	$937 - $3,853	101%
Medica [662]	$937 - $3,853	101%
Cox Health Systems Insurance Company [220]	$938 - $1,876	101%
Allied Benefits [498]	$989 - $1,978	107%
Hope Trust [806]	$989 - $1,978	107%
Health Alliance [224]	$1,194 - $2,387	129%
Healthcare Sol Mercy [609]	$1,279 - $2,558	138%
Med-Pay [480]	$1,279 - $2,558	138%
Healthscope Benefits [258]	$1,364 - $6,278	147%
Medica [661]	$1,364 - $2,728	147%
Phcs [244]	$1,364 - $2,728	147%

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 $8,732.
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 Louis Childrens 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.