CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Alton Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,925
Cash Discount Price: $3,330
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Alton Memorial Hospital is $1,925. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,330. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.08x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$3,330

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,925

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: $3,330 (359%)

Insurance Median: $1,925 (208%)

Cash: $3,330 (359% of Medicare)

Ins. Median: $1,925 (208% 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 208% of the Medicare baseline (a markup of 108%). 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
Healthscope Benefits [258]	$500 - $1,925	54%
UnitedHealthcare	$500 - $2,056	54%
Cox Health Systems Insurance Company [220]	$612 - $1,223	66%
Health Alliance [224]	$612 - $1,223	66%
Allied Benefits [498]	$645 - $5,685	70%
Hope Trust [806]	$645 - $1,290	70%
Healthcare Sol Mercy [609]	$834 - $1,668	90%
Med-Pay [480]	$834 - $1,668	90%
Medica [661]	$890 - $1,779	96%
Phcs [244]	$890 - $1,779	96%
Blue Cross Blue Shield	$967 - $2,056	104%
Aetna	$972 - $5,685	105%
Humana	$972 - $6,690	105%
Essence Healthcare [221]	$1,001 - $2,118	108%
Cox Health [757]	$1,021 - $2,159	110%
Devoted Health Plan [847]	$1,021 - $2,159	110%
Medica [662]	$1,021 - $2,159	110%
Cigna	$1,693 - $6,771	183%
Consociate [478]	$1,850 - $4,587	200%
Sarah Bush Lincoln [636]	$1,850 - $4,587	200%
Coresource [497]	$2,281 - $5,685	246%
Fmh Benefit Service Inc [222]	$2,281 - $5,685	246%
Mail Handlers [495]	$2,281 - $5,685	246%
Apwu Health Plan [216]	$2,769 - $6,771	299%
Nalc Health Benefit Plan [242]	$2,769 - $6,771	299%
Priority Health [648]	$2,769 - $6,771	299%

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 $3,330.
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 Alton Memorial 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.