CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Coryell Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $5,400
Cash Discount Price: $3,503
vs. Medicare Baseline: 5.83x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Coryell Memorial Hospital is $5,400. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,503. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 5.83x the Medicare baseline. Located in 1507 W Main Street, Gatesville, TX.

Cash / Self-Pay

$3,503

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,400

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: $3,503 (378%)

Insurance Median: $5,400 (583%)

Cash: $3,503 (378% of Medicare)

Ins. Median: $5,400 (583% 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 583% of the Medicare baseline (a markup of 483%). 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
Blue Cross Blue Shield	$365 - $7,184	39%
Aetna	$403 - $7,633	43%
Coventry	$403 - $7,633	43%
Healthrisk Resource Group	$403 - $7,633	43%
Three Rivers	$403 - $7,633	43%
Cigna	$458	49%
UnitedHealthcare	$474 - $8,980	51%
Humana	$479 - $9,070	52%
Multiplan	$479 - $9,070	52%
Scott And White	$479 - $9,070	52%
Superior	$479 - $9,070	52%
Triwest	$479 - $9,070	52%
Firstcare	$862 - $16,326	93%

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 $3,503.
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 Coryell 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.