CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Vincent's Birmingham

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,754
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.05x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Vincent's Birmingham is $3,754. 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 4.05x the Medicare baseline. Located in 810 St Vincent's Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,754

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: $3,754 (405%)

Ins. Median: $3,754 (405% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 405% of the Medicare baseline (a markup of 305%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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 - $2,528	90%
Aetna	$832 - $3,128	90%
Humana	$838 - $3,754	90%
Cigna	$854 - $3,320	92%
Prime Health Services	$871 - $5,264	94%
Seven Corners	$1,120	121%
Viva	$3,427 - $3,754	370%
Construction Claims Management	$4,126 - $4,520	445%
Corvel	$4,126 - $4,520	445%
Alamed	$4,369 - $4,786	471%
Comp One	$4,369 - $4,786	471%
Multiplan	$4,569 - $5,005	493%
Pnoa	$4,569 - $5,005	493%
Novanet	$4,854 - $5,318	524%

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 Birmingham 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.