CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: North Texas Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $864
Cash Discount Price: $1,016
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at North Texas Medical Center is $864. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,016. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.93x the Medicare baseline. Located in 1900 Hospital Blvd, Gainesville, TX.

Cash / Self-Pay

$1,016

Average discount available for prompt cash payment at this facility.

Insurance Median

$864

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: $1,016 (110%)

Insurance Median: $864 (93%)

Cash: $1,016 (110% of Medicare)

Ins. Median: $864 (93% 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
Cigna	$320 - $2,930	35%
Blue Cross Blue Shield	$400 - $3,663	43%
First Health	$480 - $4,395	52%
Healthcare Highways	$480 - $4,395	52%
Aetna	$496 - $4,542	54%
Multiplan	$560 - $5,128	60%
Provider Select	$680 - $6,226	73%
Prime Health	$720 - $6,593	78%
UnitedHealthcare	$736 - $6,739	79%
90 Degree Benefits	$864	93%
Humana	$864	93%
Molina	$864 - $950	93%
Prominence Health	$864 - $907	93%
Superior	$864 - $950	93%
Wellmed	$864	93%
Wellpoint	$864	93%
Providers Partners Health Plan	$907	98%

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 $1,016.
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 North Texas 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.