CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UT Health East Texas Rehabilitation Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,038
Cash Discount Price: $353
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UT Health East Texas Rehabilitation Hospital is $1,038. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $353. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.12x the Medicare baseline. Located in 701 Olympic Plaza Cir, Tyler, TX.

Cash / Self-Pay

$353

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,038

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: $353 (38%)

Insurance Median: $1,038 (112%)

Cash: $353 (38% of Medicare)

Ins. Median: $1,038 (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
Amerigroup Commercial [5055]	$883	95%
Black Lung [6055]	$883	95%
Cigna	$883	95%
Healthcare Highways [2210]	$883	95%
Healthscope Benefits [2290]	$883	95%
Lucent Health [6000]	$883	95%
Parkland Community Health Plan [6015]	$883	95%
Web Tpa [2115]	$883 - $1,459	95%
Blue Cross Blue Shield	$1,194 - $1,805	129%
Aetna	$1,459	157%
Mailhandlers [1595]	$1,459	157%
Andrews Center Behavioral Health [3950]	$1,766	191%
Healthfirst [2395]	$1,766	191%

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 $353.
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 UT Health East Texas Rehabilitation 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.