CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: North Austin Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,244
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at North Austin Medical Center is $2,244. 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 2.42x the Medicare baseline. Located in 12221 Mopac Expressway North, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,244

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: $2,244 (242%)

Ins. Median: $2,244 (242% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 242% of the Medicare baseline (a markup of 142%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$204	22%
St David’S Hospice	$335	36%
Blue Cross Blue Shield	$352 - $2,232	38%
United	$359 - $5,947	39%
Molina Healthcare	$368	40%
Humana	$419	45%
Sendero	$419	45%
Aetna	$469 - $5,457	51%
Superior Health Plan	$929	100%
Nomi Health	$2,256 - $2,375	243%
Curative Administrators	$2,613	282%
Evry Health	$2,894	312%
Healthcare Highways	$3,097 - $3,160	334%
Harbor Health Team	$3,230	349%
Cigna	$3,375 - $4,304	364%
Moda Health	$3,385 - $3,453	365%
Oscar	$3,623 - $4,282	391%
Moda	$4,023	434%

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 North Austin 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.