CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ascension Seton Southwest

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $909
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ascension Seton Southwest is $909. 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 0.98x the Medicare baseline. Located in 7900 Fm 1826, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$909

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: $909 (98%)

Ins. Median: $909 (98% 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
Champva	$141 - $144	15%
Blue Cross Blue Shield	$335 - $920	36%
Dell Chip/Chip Perinate	$335	36%
Dell Star	$335	36%
UnitedHealthcare	$335 - $927	36%
Wellpoint Chip/Chip Perinate	$335	36%
Wellpoint Star	$335	36%
Wellpoint Star Kids	$335	36%
Wellpoint Star Plus	$335	36%
Tricare	$720 - $909	78%
Aarp Mc Wellmed	$890	96%
Sendero Chap	$900	97%
Addr Cancer Together	$909	98%
Aetna	$909	98%
Covid Hrsa	$909	98%
Cshcn Cidc	$909	98%
Devoted Health Mcr Replacement	$909	98%
Humana	$909 - $969	98%
Medicare (plans)	$909	98%
Research Study	$909	98%
Smarthealth	$909	98%
Superior Allwell	$909	98%
Wellcare Med Advantage	$909	98%
Connected Senior Care	$936	101%
Pphp Mcr Advantage	$954	103%
Tx Independence Hp	$954	103%
Oscar Health Exchange	$1,000	108%
Occunet	$1,272	137%
Sendero Idealcare	$1,590	172%
Ambetter / Centene	$1,635	176%

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 Ascension Seton Southwest 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.