CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Doctors Hosptal at Renaissance

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,881
Cash Discount Price: $7,382
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Doctors Hosptal at Renaissance is $1,881. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,382. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.03x the Medicare baseline. Located in 5501 South McColl, Edinburg, TX.

Cash / Self-Pay

$7,382

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,881

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: $7,382 (797%)

Insurance Median: $1,881 (203%)

Cash: $7,382 (797% of Medicare)

Ins. Median: $1,881 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Molina	$359 - $1,152	39%
Driscoll	$363	39%
UnitedHealthcare	$363	39%
Superior	$370 - $1,152	40%
Wellcare/Allwell	$370	40%
Humana	$922	100%
Blue Cross Blue Shield	$940 - $1,893	101%
Wellcare	$968	104%
Cl Frates	$1,198 - $2,074	129%
Aetna	$1,355 - $3,741	146%
Healthsmart	$1,742 - $3,741	188%

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 $7,382.
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 Doctors Hosptal at Renaissance 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.