CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Monroe County Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$770

about 0.8× the $927 Medicare rate · typically $531–$1,386

modeled estimate · not a bill or quote

What this hospital charges insurers

$820

About the fair price

about $50 over the fair price · 0.9× Medicare

Medicare pays $927 Fair price $770 This hospital $820 Cash price $439 Hospital's list price $1,097

How we calculate the fair BaseRate →

How this hospital compares to other AL hospitals

Highest price of the 9 AL hospitals we have prices for — worth calling around.

Cheapest $318 Priciest $820

Black dot = this hospital, among the 9 AL hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $770 (about 0.8× the $927 Medicare rate). Monroe County Hospital charges insurers about $820, or about $439 in cash — about the fair price. Located in Monroeville, AL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$820 - $837	88%
Blue Cross Blue Shieldmajor	$820	88%
Cignamajor	$439	47%
Humanamajor	$820	88%

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 439), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Monroe County Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at Monroe County Hospital

Compare: Upper endoscopy with biopsy at other AL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.