CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Terrebonne General Medical Center - Parish

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,522
Cash Discount Price: $1,816
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Terrebonne General Medical Center - Parish is $1,522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,816. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.64x the Medicare baseline. Located in 8166 Main Street, Houma, LA.

Cash / Self-Pay

$1,816

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,522

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: $1,816 (196%)

Insurance Median: $1,522 (164%)

Cash: $1,816 (196% of Medicare)

Ins. Median: $1,522 (164% 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
Medicaid / KanCare	$439	47%
UnitedHealthcare	$439 - $3,647	47%
Amerihealth	$448	48%
Aetna	$452 - $2,011	49%
Humana	$461 - $2,470	50%
Champ Va	$535	58%
Blue Cross Blue Shield	$808 - $1,957	87%
Dept Of Veterans Affairs	$808	87%
Medicare (plans)	$808	87%
Tricare	$821	89%
Amg	$862	93%
Ppoplus	$1,118	121%
Verity Health	$1,398	151%
Multiplan Inc	$1,594	172%
Cigna	$1,646	178%
Coventry Health Of Louisiana	$1,962	212%
Vantage Health Plan	$2,053	222%
Gilsbar 360	$2,279 - $2,307	246%
Workers Comp	$2,453	265%

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 $1,816.
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 Terrebonne General Medical Center - Parish 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.