CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Texoma Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,560
Cash Discount Price: $3,838
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Texoma Medical Center is $1,560. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,838. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.68x the Medicare baseline. Located in 5016 S Us Highway 75, Denison, TX.

Cash / Self-Pay

$3,838

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,560

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: $3,838 (414%)

Insurance Median: $1,560 (168%)

Cash: $3,838 (414% of Medicare)

Ins. Median: $1,560 (168% 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
Superior	$342 - $370	37%
Molina	$370 - $3,633	40%
Tchp	$370 - $5,158	40%
Amerigroup	$567	61%
United_Healthcare	$567 - $5,158	61%
Blue_Cross_Blue_Shield_Of_Tx	$1,030 - $1,273	111%
Aetna	$1,433	155%
Cigna	$1,688 - $2,031	182%
Healthchoice	$1,688 - $3,838	182%
Multiplan	$3,633	392%
Healthsmart	$3,838 - $4,352	414%
Humana	$4,352	470%

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 $3,838.
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 Texoma 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.