CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Tops Surgical Specialty Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,232
Cash Discount Price: $474
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Tops Surgical Specialty Hospital is $1,232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $474. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.33x the Medicare baseline. Located in 17080 Red Oak Drive, Houston, TX.

Cash / Self-Pay

$474

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,232

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: $474 (51%)

Insurance Median: $1,232 (133%)

Cash: $474 (51% of Medicare)

Ins. Median: $1,232 (133% 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
Oscar Health Plan	$168 - $1,530	18%
Ambetter / Centene	$192 - $2,473	21%
UnitedHealthcare	$294 - $2,571	32%
Health Net	$602 - $1,151	65%
Blue Cross Blue Shield	$609 - $1,770	66%
Humana	$655 - $2,628	71%
Aetna	$1,317 - $3,378	142%
Cigna	$4,016 - $5,394	433%

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 $474.
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 Tops Surgical Specialty Hospital 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.