CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Baylor Scott and White Orthopedic and Spine Hospi

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,090

about 1.2× the $927 Medicare rate · typically $755–$1,833

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $1,090

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna AetnaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,659 - $2,872	179%
Blue Cross Blue Shieldmajor	$1,987 - $8,427	214%
Cignamajor	$3,303 - $5,101	356%

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Baylor Scott and White Orthopedic and Spine Hospi is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Other Procedures at Baylor Scott and White Orthopedic and Spine Hospi

Compare: Upper endoscopy with biopsy at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.