CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mission Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $957
Cash Discount Price: $906
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mission Regional Medical Center is $957. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $906. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.03x the Medicare baseline. Located in 900 South Bryan Road, Mission, TX.

Cash / Self-Pay

$906

Average discount available for prompt cash payment at this facility.

Insurance Median

$957

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: $906 (98%)

Insurance Median: $957 (103%)

Cash: $906 (98% of Medicare)

Ins. Median: $957 (103% 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
Aetna	$907	98%
Blue Cross Blue Shield	$907 - $1,132	98%
Cigna	$907 - $1,733	98%
Medicare (plans)	$907	98%
Superior Health Plan	$907 - $1,179	98%
Tricare	$907	98%
UnitedHealthcare	$907	98%
Wellmed	$907	98%
Worker Comp	$907	98%
Molina	$952 - $1,405	103%
Imperial Insurance Companies	$961	104%
Employer Direct Healthcare	$1,179	127%
Frontier Health (Fka Asserta Health)	$1,179	127%
Magic Valley Electric Cooperative	$1,179	127%
Corporate Remedies	$1,360	147%
Naphcare	$1,405	152%
Baker Benefits Administrators	$1,813	196%

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 $906.
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 Mission 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.