CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hendrick Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,799
Cash Discount Price: $6,362
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hendrick Medical Center is $2,799. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,362. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.02x the Medicare baseline. Located in 1900 Pine, Abilene, TX.

Cash / Self-Pay

$6,362

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,799

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: $6,362 (687%)

Insurance Median: $2,799 (302%)

Cash: $6,362 (687% of Medicare)

Ins. Median: $2,799 (302% 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 302% of the Medicare baseline (a markup of 202%). 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
Blue Cross Blue Shield	$1,145 - $2,799	124%
Baylor Scott And White Health Plan	$1,871	202%
UnitedHealthcare	$2,481 - $3,499	268%
Aetna	$4,008	433%
Private Healthcare Systems	$4,136 - $5,090	446%
Cigna	$4,200	453%
Healthsmart	$4,772	515%
Omni Networks	$4,772 - $5,408	515%
Multiplan	$5,662	611%

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 $6,362.
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 Hendrick 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.