CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: CHI St Lukes Lakeside Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,033
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at CHI St Lukes Lakeside Hospital is $1,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.11x the Medicare baseline. Located in 17400 St Lukes Way, The Woodlands, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,033

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%)

Insurance Median: $1,033 (111%)

Ins. Median: $1,033 (111% 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
Tchp	$335 - $449	36%
Wellpoint	$335 - $1,409	36%
United	$342 - $3,778	37%
UnitedHealthcare	$342 - $1,045	37%
Blue Cross Blue Shield	$352 - $1,509	38%
Chc	$385 - $516	42%
Renaissance	$676	73%
Cigna	$939 - $7,221	101%
Humana	$939 - $1,782	101%
Kelsey	$939	101%
Selectcare	$939	101%
Aetna	$958 - $1,446	103%
Amerivantage	$967	104%
Devoted	$1,005	108%
Scanhealth	$1,005	108%
Kindred	$1,033	111%
Kelseycare	$1,268 - $1,362	137%
Bright Health	$1,353	146%
Ambetter / Centene	$1,409	152%
Community Health Choice	$1,409	152%
Harris Health	$1,409	152%
Independent Med System	$1,675	181%
Nx Health	$3,052	329%
PHCS	$5,185	560%
PHCS Savility	$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 $X.
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 CHI St Lukes Lakeside 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.