CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Titus Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $256
Cash Discount Price: $691
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Titus Regional Medical Center is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $691. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.28x the Medicare baseline. Located in 2001 N Jefferson, Mount Pleasant, TX.

Cash / Self-Pay

$691

Average discount available for prompt cash payment at this facility.

Insurance Median

$256

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: $691 (75%)

Insurance Median: $256 (28%)

Cash: $691 (75% of Medicare)

Ins. Median: $256 (28% 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
Christus Health Plan	$96	10%
Humana	$96 - $806	10%
Tricare	$96	10%
Triwest	$96 - $419	10%
UnitedHealthcare	$96 - $904	10%
Texas Mutual	$98	11%
Curative	$105	11%
Superior	$115	12%
Blue Cross Blue Shield	$134 - $1,209	14%
Healthcare Highways	$179	19%
Aetna	$207 - $333	22%
Claritev	$415	45%
Healthsmart	$806	87%
Cigna	$922	100%
Galaxy Health	$1,094	118%

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 $691.
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 Titus Regional Medical 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.