CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Texas Health Harris Methodist Hospital Cleburne

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $939
Cash Discount Price: $732
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Texas Health Harris Methodist Hospital Cleburne is $939. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $732. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.01x the Medicare baseline. Located in 201 Walls Drive, Cleburne, TX.

Cash / Self-Pay

$732

Average discount available for prompt cash payment at this facility.

Insurance Median

$939

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: $732 (79%)

Insurance Median: $939 (101%)

Cash: $732 (79% of Medicare)

Ins. Median: $939 (101% 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
Amerigroup	$335 - $939	36%
Blue Cross Blue Shield	$335 - $6,567	36%
Cook Childrens	$335	36%
UnitedHealthcare	$335 - $3,751	36%
Superior Wellcare	$352 - $984	38%
Molina	$362 - $939	39%
Aetna	$368 - $855	40%
City Of Fort Worth	$573	62%
Cigna	$674 - $1,148	73%
Fort Worth Firefighters	$744 - $2,319	80%
Quick Trip	$866	93%
American Health	$894	96%
Healthspring	$912	98%
Humana	$930	100%
Phcs	$1,020	110%
Healthsmart	$1,061 - $1,171	115%
Multiplan	$1,061	115%
Galaxy	$1,073	116%
Usa	$1,073	116%

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 $732.
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 Texas Health Harris Methodist Hospital Cleburne 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.