CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Texas Health Presbyterian Hospital Dallas

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,109
Cash Discount Price: $1,220
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Texas Health Presbyterian Hospital Dallas is $1,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,220. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.20x the Medicare baseline. Located in 8200 Walnut Hill Lane, Dallas, TX.

Cash / Self-Pay

$1,220

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,109

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: $1,220 (132%)

Insurance Median: $1,109 (120%)

Cash: $1,220 (132% of Medicare)

Ins. Median: $1,109 (120% 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 - $957	36%
Blue Cross Blue Shield	$335 - $6,567	36%
Parkland	$335	36%
UnitedHealthcare	$335 - $3,751	36%
Superior Wellcare	$352 - $1,002	38%
Molina	$362 - $957	39%
Aetna	$471 - $1,995	51%
City Of Fort Worth	$573 - $1,338	62%
Cigna	$674 - $2,678	73%
Quick Trip	$732 - $1,793	79%
Fort Worth Firefighters	$744 - $2,319	80%
Phcs	$848 - $2,120	92%
American Health	$911	98%
Healthsmart	$915 - $2,391	99%
Healthspring	$929	100%
Humana	$948	102%
Multiplan	$1,061 - $2,476	115%
Galaxy	$1,073 - $2,504	116%
Usa	$1,073 - $2,504	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 $1,220.
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 Presbyterian Hospital Dallas 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.