CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Bsa Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $3,639
- Cash Discount Price: $520
- vs. Medicare Baseline: 3.93x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Bsa Hospital is $3,639. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $520. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.93x the Medicare baseline. Located in 1600 Wallace Blvd, Amarillo, TX.
Cash / Self-Pay
$520
Average discount available for prompt cash payment at this facility.
Insurance Median
$3,639
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: $520 (56%)
Insurance Median: $3,639 (393%)
Cash: $520 (56% of Medicare)
Ins. Median: $3,639 (393% 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 393% of the Medicare baseline (a markup of 293%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $1,548 - $2,028 | 167% |
| Healthscope Benefits [2290] | $1,733 - $2,028 | 187% |
| UnitedHealthcare | $1,733 - $3,780 | 187% |
| Insurance Management Services (Ims) [1540] | $1,820 - $2,340 | 196% |
| Aetna | $2,028 - $3,899 | 219% |
| Amerigroup Commercial [5055] | $2,028 | 219% |
| Black Lung [6055] | $2,028 | 219% |
| Caprock Health Plans [1200] | $2,028 | 219% |
| Cigna | $2,028 - $3,774 | 219% |
| Curative [7085] | $2,028 | 219% |
| Healthcare Highways [2210] | $2,028 | 219% |
| Horizon Nj Health [3635] | $2,028 | 219% |
| Infusion Copay Assistance [6060] | $2,028 | 219% |
| Lucent Health [6000] | $2,028 | 219% |
| Midland Pace Mcaid [3715] | $2,028 | 219% |
| Oncology Patient Assistance Programs [2295] | $2,028 | 219% |
| Texas Childrens Health Plan [3995] | $2,028 | 219% |
| Web Tpa [2115] | $2,028 - $3,899 | 219% |
| Maxor Insurance [1610] | $2,444 | 264% |
| American Healthcare [1055] | $2,600 | 281% |
| Group Pension Admin [1450] | $2,600 | 281% |
| Sana Benefits [5005] | $2,600 | 281% |
| Texas Rehab [1965] | $2,963 | 320% |
| Texas Rehabilitation [1970] | $2,963 | 320% |
| Nreca [1735] | $3,187 | 344% |
| Tml [1980] | $3,187 | 344% |
| United Behavioral Health [3820] | $3,187 | 344% |
| Administrative Concepts [1005] | $3,639 | 393% |
| Alieracare [2935] | $3,639 | 393% |
| Americas Choice Health Plans [1090] | $3,639 | 393% |
| Assurant Health [1105] | $3,639 - $3,899 | 393% |
| Beech Street [1170] | $3,639 | 393% |
| Benefit Management [1175] | $3,639 | 393% |
| Cbsa [1215] | $3,639 | 393% |
| Celtic Life [1220] | $3,639 | 393% |
| Cherokee Insurance [1245] | $3,639 | 393% |
| Comcar Industries [1280] | $3,639 | 393% |
| Equitable [1355] | $3,639 | 393% |
| Federated Mutual [1365] | $3,639 | 393% |
| Ge Group Administrators [1405] | $3,639 | 393% |
| Guardian [1465] | $3,639 | 393% |
| Insurers Administrative Corp [1550] | $3,639 | 393% |
| Lewer Agency [1565] | $3,639 | 393% |
| Medica [2910] | $3,639 | 393% |
| Medishare Christian Care [1645] | $3,639 | 393% |
| Mega Life And Health [1650] | $3,639 | 393% |
| Northamerica Administrators [1725] | $3,639 | 393% |
| Pan American Life Insurance Co [1770] | $3,639 | 393% |
| Phcs [1780] | $3,639 | 393% |
| Phoenix Home Life [1785] | $3,639 | 393% |
| Principal Mutual Life [1845] | $3,639 | 393% |
| Rh Administrators [1885] | $3,639 | 393% |
| Trustmark [2030] | $3,639 - $3,899 | 393% |
| Coresource [1315] | $3,774 | 407% |
| Healthpartners [1500] | $3,774 | 407% |
| National Association Of Letter Carriers [1695] | $3,774 | 407% |
| Allied Benefit Systems Inc [1030] | $3,899 | 421% |
| American Veterinary [1085] | $3,899 | 421% |
| Cba Administrators [1210] | $3,899 | 421% |
| Coventry Healthcare [1320] | $3,899 | 421% |
| Fmh Benefit Services [1390] | $3,899 | 421% |
| Gilsbar [1425] | $3,899 | 421% |
| Healthnet [1495] | $3,899 | 421% |
| Mailhandlers [1595] | $3,899 | 421% |
| Meritain Health [1655] | $3,899 | 421% |
| Reserve National [1880] | $3,899 | 421% |
| Rural Carrier Benefit Plan [1895] | $3,899 | 421% |
| Allied National Global Care [1035] | $4,419 | 477% |
| Combined Insurance Of America [1275] | $4,419 | 477% |
| Freedom Life Insurance [1400] | $4,419 | 477% |
| Group Health [2165] | $4,419 | 477% |
| Kaiser Permanente [1560] | $4,419 | 477% |
| Multiplan [1680] | $4,419 | 477% |
| Mutual Of Omaha [1685] | $4,419 | 477% |
| New Era Life Insurance Company [1705] | $4,419 | 477% |
| Pba [1775] | $4,419 | 477% |
| Planned Administrators Inc [2360] | $4,419 | 477% |
| Universal Fidelity [2085] | $4,419 | 477% |