CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Tulsa Spine & Specialty Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,244
Cash Discount Price: $759
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Tulsa Spine & Specialty Hospital is $1,244. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $759. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.34x the Medicare baseline. Located in 6901 South Olympia Avenue, Tulsa, OK.

Cash / Self-Pay

$759

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,244

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: $759 (82%)

Insurance Median: $1,244 (134%)

Cash: $759 (82% of Medicare)

Ins. Median: $1,244 (134% 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
Black Lung [6055]	$759	82%
Healthcare Highways [2210]	$759 - $1,244	82%
Lucent Health [6000]	$759	82%
Oncology Patient Assistance Programs [2295]	$759	82%
Oscar Insurance Company [7005]	$759	82%
Osma Health Network [2345]	$759	82%
Resource One Administrators [2815]	$1,244	134%
Universal Fidelity [2085]	$1,244	134%
Web Tpa [2115]	$1,244	134%
The Kempton Group Administrators [2905]	$1,365	147%
Cigna	$1,820	196%
National Association Of Letter Carriers [1695]	$1,820	196%
Pba [1775]	$1,820	196%
First Health [1375]	$1,875	202%
Medica [2910]	$1,875	202%
Multiplan [1680]	$1,875	202%

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 $759.
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 Tulsa Spine & Specialty 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.