CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Texas Health Center for Diagnostics & Surgery Plan

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$947

about 1.0× the $927 Medicare rate · typically $772–$1,360

modeled estimate · not a bill or quote

What this hospital charges insurers

$947

About the fair price

1.0× Medicare

Medicare pays $927 Fair price $947 This hospital $947 Cash price $732 Hospital's list price $1,220

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $100 Priciest $947

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $947 (about 1.0× the $927 Medicare rate). Texas Health Center for Diagnostics & Surgery Plan charges insurers about $947, or about $732 in cash — about the fair price. Located in Plano, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$335 - $3,751	36%
Blue Cross Blue Shieldmajor	$335 - $6,567	36%
Aetnamajor	$503 - $855	54%
Cignamajor	$674 - $1,148	73%
Humanamajor	$938	101%
Amerigroup	$335 - $947	36%
Cigna HealthSpring	$920	99%
Molina	$362 - $947	39%
WellCare	$352 - $992	38%
+ 6 smaller / regional plans	$335 - $2,319

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 732), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Texas Health Center for Diagnostics & Surgery Plan is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Texas Health Center for Diagnostics & Surgery Plan

Compare: Upper endoscopy with biopsy at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.