CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Luke's Patients Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,409
Cash Discount Price: $1,326
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Luke's Patients Medical Center is $1,409. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,326. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.52x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$1,326

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,409

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: $1,326 (143%)

Insurance Median: $1,409 (152%)

Cash: $1,326 (143% of Medicare)

Ins. Median: $1,409 (152% 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
Chc	$318	34%
Tchp	$318	34%
Wellpoint	$335 - $1,409	36%
United	$342 - $3,778	37%
Blue Cross Blue Shield	$589 - $1,509	64%
Cigna	$939 - $7,221	101%
Humana	$939 - $1,782	101%
Kelsey	$939	101%
Aetna	$958 - $2,880	103%
Amerivantage	$967	104%
Devoted	$1,005	108%
Scanhealth	$1,005	108%
Bright Health	$1,353	146%
Ambetter / Centene	$1,409	152%
Community Health Choice	$1,409	152%
Coventry	$2,463	266%
First Health	$2,463	266%
Healthsmart	$2,653	286%
Multiplan	$2,842	307%
PHCS	$5,185	560%

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 $1,326.
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 St Luke's Patients Medical Center 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.