CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Womans Hospital of Texas,The

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,226
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Womans Hospital of Texas,The is $1,226. 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 1.32x the Medicare baseline. Located in 7600 Fannin, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,226

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: $1,226 (132%)

Ins. Median: $1,226 (132% 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	$328	35%
Amerigroup	$352	38%
United	$359 - $3,262	39%
Molina Healthcare	$368	40%
Community Health Choice Mcd	$375	40%
Humana	$419 - $4,690	45%
Aetna	$423 - $2,585	46%
Wellmed	$916	99%
Superior Health Plan	$948	102%
Blue Cross Blue Shield	$1,085 - $1,257	117%
Fidelis Securecare Of Tx	$2,115	228%
Evry Health	$2,431	262%
Healthcare Highways	$2,434	263%
Curative Administrators	$2,613	282%
Cigna	$2,957 - $3,810	319%
Oscar	$2,979	321%
Kelsey Care (Boon-Chapman)	$4,255	459%

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 Womans Hospital of Texas,The 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.