CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: El Paso Children's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,345
Cash Discount Price: $656
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at El Paso Children's Hospital is $1,345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $656. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.45x the Medicare baseline. Located in 4845 Alameda Avenue, El Paso, TX.

Cash / Self-Pay

$656

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,345

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: $656 (71%)

Insurance Median: $1,345 (145%)

Cash: $656 (71% of Medicare)

Ins. Median: $1,345 (145% 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 Tx	$335	36%
Point Comfort Underwriters	$335	36%
Superior	$335	36%
El Paso Health Plans	$342	37%
El Paso First Health Plan	$350 - $961	38%
Molina Tx	$368	40%
Uh Military Va	$368	40%
Health Net Fed Svcs	$397	43%
Blue Cross Blue Shield	$409 - $3,604	44%
Western Sky	$929 - $2,547	100%
UnitedHealthcare	$1,258 - $3,450	136%
Aetna	$1,261 - $3,844	136%
Cigna	$1,375 - $3,772	148%
Coventry Health Care	$1,402 - $3,844	151%
Fortified Provider Network	$1,402 - $3,844	151%
Multiplan	$1,402 - $3,844	151%
Molina Nm	$1,533	165%

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 $656.
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 El Paso Children's 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.