CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Medical Center Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $906
Cash Discount Price: $1,159
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Medical Center Hospital is $906. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,159. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.98x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$1,159

Average discount available for prompt cash payment at this facility.

Insurance Median

$906

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: $1,159 (125%)

Insurance Median: $906 (98%)

Cash: $1,159 (125% of Medicare)

Ins. Median: $906 (98% 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
Ambetter / Centene	$299 - $941	32%
Amerigroup	$299	32%
Blue Cross Blue Shield	$299 - $1,383	32%
Community Health Choice	$299	32%
First Care Health Plan	$299	32%
Superior Health Plan	$299	32%
UnitedHealthcare	$299 - $1,403	32%
Corvel Wc	$311 - $335	34%
Medicaid / KanCare	$352 - $370	38%
Superior Chips	$352	38%
Cigna	$430 - $1,742	46%
Aetna	$634 - $1,913	68%
Health Select	$779 - $959	84%
90 Degree Benefits	$869	94%
Humana	$880	95%
Novitas Solutions	$897	97%
Triwest Va Ccn	$897	97%
State Comptroller	$906	98%
Care Improvement Plus	$911	98%
Wellcare By Allwell	$941	102%
Firstcare	$981	106%
Healthsmart Preferred Care	$1,087 - $1,590	117%
Group Resources	$1,093	118%
Texas Mutual Wc	$1,195	129%
Caprock	$1,357 - $1,580	146%
Geha	$1,403	151%
Workers Comp	$1,822	197%

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 $1,159.
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 Medical Center 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.