CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ward Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $718
Cash Discount Price: $727
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ward Memorial Hospital is $718. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $727. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.77x the Medicare baseline. Located in 406 South Gary St, Monahans, TX.

Cash / Self-Pay

$727

Average discount available for prompt cash payment at this facility.

Insurance Median

$718

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: $727 (78%)

Insurance Median: $718 (77%)

Cash: $727 (78% of Medicare)

Ins. Median: $718 (77% 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
Blue Cross Blue Shield	$90 - $2,644	10%
Firstcare	$90 - $732	10%
Medicare (plans)	$90 - $718	10%
Superior Healthplan	$90 - $718	10%
Cigna	$277 - $2,206	30%
Corecare	$333 - $2,644	36%
Texas True Choice	$356 - $2,833	38%
Unicare	$380 - $3,022	41%
Galaxy Health Network	$428 - $3,399	46%
Multiplan	$428 - $3,399	46%
Usa Health Network	$428 - $3,399	46%
Usc Health Services	$428 - $3,399	46%
Aetna	$470 - $3,739	51%

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 $727.
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 Ward Memorial Hospital 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.