CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Medical City Lewisville

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,729
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Medical City Lewisville is $1,729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.87x the Medicare baseline. Located in 500 West Main Street, Lewisville, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,729

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%)

Insurance Median: $1,729 (187%)

Ins. Median: $1,729 (187% 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
Texas Health Network	$330	36%
Cook Childrens Health Plan	$335	36%
Parkland Community Health Plan	$335	36%
United	$335 - $3,150	36%
Amerigroup	$352	38%
Cigna	$352 - $3,486	38%
Molina	$368 - $375	40%
Aetna	$402 - $4,332	43%
Humana	$419 - $4,926	45%
Wellmed	$916	99%
Blue Cross Blue Shield	$975 - $2,028	105%
Fidelis Securecare	$1,995	215%
Healthcare Highways	$2,129	230%
Evry Health	$2,356	254%
Curative Administrators	$2,613	282%
Multiplan Phcs	$3,972	429%
Oscar	$4,723	510%

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 $X.
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 Medical City Lewisville 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.