CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: USA Health Children's & Women's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $627
Cash Discount Price: $1,046
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at USA Health Children's & Women's Hospital is $627. 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 0.68x the Medicare baseline. Located in 1700 Center Street, Mobile, AL.

Cash / Self-Pay

$1,046

Average discount available for prompt cash payment at this facility.

Insurance Median

$627

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: $627 (68%)

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

Ins. Median: $627 (68% 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
Blue Cross Blue Shield	$410	44%
Aetna	$419 - $1,032	45%
Devoted Health	$419 - $1,313	45%
Humana	$419 - $1,219	45%
UnitedHealthcare	$419 - $672	45%
Viva Health	$419 - $938	45%
Wellcare	$419	45%
Cigna	$459 - $1,219	50%
Molina Marketplace	$461	50%
Central Healthcare Services	$482 - $938	52%
Ambetter / Centene	$503	54%
Mississippi Physicians Care Network (Mpcn)	$565	61%
Multiplan	$627 - $1,313	68%
Magnolia Health	$672	73%
Truecare	$672	73%
Molina Chip	$739	80%
Novanet	$868 - $1,688	94%

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 USA Health Children's & Women's 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.