CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St. Vincent's East

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,452
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St. Vincent's East is $1,452. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.57x the Medicare baseline. Located in 50 Medical Park East Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,452

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%)

Insurance Median: $1,452 (157%)

Ins. Median: $1,452 (157% 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
Ambetter / Centene	$115 - $1,141	12%
Blue Cross Blue Shield	$796	86%
Cooper Green	$830	90%
UnitedHealthcare	$830 - $2,198	90%
Viva	$830 - $2,645	90%
Humana	$838 - $2,645	90%
Aetna	$854 - $2,204	92%
Cigna	$854 - $3,644	92%
Prime Health Services	$871 - $3,710	94%
Seven Corners	$1,120	121%
Construction Claims Management	$3,186	344%
Corvel	$3,186	344%
Alamed	$3,373	364%
Multiplan	$3,527	381%
Pnoa	$3,527	381%

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 $X.
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. Vincent's East 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.