CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: University of Texas M. D. Anderson Cancer Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,304
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.49x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at University of Texas M. D. Anderson Cancer Center is $2,304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.49x the Medicare baseline. Located in 1515 Holcombe Blvd, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,304

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%)

Insurance Median: $2,304 (249%)

Ins. Median: $2,304 (249% 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 249% of the Medicare baseline (a markup of 149%). 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
Texaschildrens	$101 - $1,448	11%
Tricare	$117 - $2,469	13%
Vacare	$117 - $1,538	13%
Medicare (plans)	$165 - $1,448	18%
UnitedHealthcare	$201 - $2,469	22%
Blue Cross Blue Shield	$241 - $2,370	26%
Aetna	$303 - $2,469	33%
Cigna	$310 - $2,469	33%
Humana	$869 - $2,535	94%
Ontarioministriesofhealth	$1,072 - $2,436	116%
Beijingst.Lucia	$1,087 - $2,469	117%
Embassyofqatar	$1,087 - $2,469	117%
Memorialhermannhealth	$1,087 - $2,469	117%
Emergingtherapysolutions_Cancercare	$1,159 - $2,634	125%
Interlink_Cancercare	$1,159 - $2,634	125%
Saudiarmedforces	$1,159 - $2,634	125%
Uae_Medical	$1,159 - $2,634	125%
Uaepoliceattache	$1,159 - $2,634	125%
Healthsmart	$1,232 - $2,798	133%
Vantage	$1,232 - $2,798	133%
Multiplan	$1,443 - $2,831	156%
Phcs	$1,443 - $2,831	156%
Emergingtherapysolutions	$2,469 - $2,634	266%
Interlink	$2,469 - $2,798	266%

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 $X.
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 University of Texas M. D. Anderson Cancer Center 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.