CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Baylor Scott & White Medical Center Plano

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,040
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Baylor Scott & White Medical Center Plano is $1,040. 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 1.12x the Medicare baseline. Located in 4700 Alliance Boulevard, Plano, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,040

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: $1,040 (112%)

Ins. Median: $1,040 (112% 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
Superior Health Plan	$335 - $870	36%
Baylor Scott & White Health Plan	$788 - $1,368	85%
Aetna	$829 - $5,016	89%
Humana	$829	89%
Triwest	$829	89%
Corvel	$868	94%
Prime Health Services	$868	94%
American Health Plan	$870	94%
Blue Cross Blue Shield	$870 - $2,656	94%
Healthspring	$870	94%
Procare Advantage	$870	94%
UnitedHealthcare	$953 - $2,960	103%
Ambetter / Centene	$1,716	185%
Healthsmart	$3,282	354%
Cigna	$3,779 - $4,446	408%

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 Baylor Scott & White Medical Center Plano 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.