CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Seton Medical Center Harker Heights

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,024
Cash Discount Price: $266
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Seton Medical Center Harker Heights is $1,024. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $266. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.11x the Medicare baseline. Located in 850 W Central Texas Expressway, Harker Heights, TX.

Cash / Self-Pay

$266

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,024

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: $266 (29%)

Insurance Median: $1,024 (111%)

Cash: $266 (29% of Medicare)

Ins. Median: $1,024 (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
Medicaid / KanCare	$287 - $1,243	31%
Healthscope Benefits [2290]	$383 - $574	41%
UnitedHealthcare	$383 - $1,243	41%
Aetna	$393 - $1,830	42%
Bell County Indigent Health Svc [3530]	$403 - $605	43%
Healthcare Highways [2210]	$829 - $1,243	89%
Oncology Patient Assistance Programs [2295]	$829 - $1,243	89%
Selecthealth [3740]	$829 - $1,243	89%
Web Tpa [2115]	$829 - $2,551	89%
Blue Cross Blue Shield	$1,573 - $2,359	170%
First Care Commercial [1371]	$1,594 - $2,391	172%
Allied Benefit Systems Inc [1030]	$1,700 - $2,551	183%
Cigna	$1,841 - $2,761	199%

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 $266.
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 Seton Medical Center Harker Heights 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.