CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Fort Duncan Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,886
Cash Discount Price: $1,755
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Fort Duncan Medical Center is $1,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,755. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.04x the Medicare baseline. Located in 3333 N Foster Maldonado Blvd, Eagle Pass, TX.

Cash / Self-Pay

$1,755

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,886

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: $1,755 (189%)

Insurance Median: $1,886 (204%)

Cash: $1,755 (189% of Medicare)

Ins. Median: $1,886 (204% 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 204% of the Medicare baseline (a markup of 104%). 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
Superior	$107	12%
Molina	$112	12%
Driscoll	$270	29%
United_Healthcare	$277 - $1,799	30%
Blue_Cross_Blue_Shield_Of_Tx	$1,753 - $2,837	189%
Eagle_Pass_Isd	$1,886	204%
Cigna	$2,746	296%
Aetna	$3,466	374%
Healthsmart	$4,168	450%
Multiplan	$4,168	450%

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 $1,755.
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 Fort Duncan 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.