CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The East Alabama Healthcare Authority

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $951
Cash Discount Price: $1,046
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at The East Alabama Healthcare Authority is $951. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,046. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.03x the Medicare baseline. Located in 2000 Pepperell Parkway, Opelika, AL.

Cash / Self-Pay

$1,046

Average discount available for prompt cash payment at this facility.

Insurance Median

$951

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: $1,046 (113%)

Insurance Median: $951 (103%)

Cash: $1,046 (113% of Medicare)

Ins. Median: $951 (103% 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	$123 - $1,901	13%
Blue Cross Blue Shield	$123 - $1,377	13%
Cigna	$123 - $1,672	13%
Humana	$123 - $1,607	13%
Simpra	$123 - $850	13%
Viva	$123 - $2,111	13%
Novanet	$285	31%
Beechstreet	$761 - $1,616	82%
Alabama Crime Victims	$950	103%
Mcm Maxcare	$1,521	164%
Mega Life	$1,521	164%
UnitedHealthcare	$1,521	164%
Coventry First Health	$1,616	174%
Geha	$1,616	174%
Multiplan	$1,616	174%
Workers Comp	$1,616	174%
Trpn	$1,711	185%

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 $1,046.
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 The East Alabama Healthcare Authority 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.