CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Crescent Medical Center Lancaster

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,416
Cash Discount Price: $7,910
vs. Medicare Baseline: 2.61x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Crescent Medical Center Lancaster is $2,416. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,910. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.61x the Medicare baseline. Located in 2600 West Pleasant Run Road, Lancaster, TX.

Cash / Self-Pay

$7,910

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,416

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: $7,910 (854%)

Insurance Median: $2,416 (261%)

Cash: $7,910 (854% of Medicare)

Ins. Median: $2,416 (261% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 261% of the Medicare baseline (a markup of 161%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Oscar	$743 - $4,124	80%
Wellmed	$823	89%
Aetna	$840	91%
Choice Care	$840	91%
Superior Health Plan	$840	91%
UnitedHealthcare	$840	91%
Wellcare	$840	91%
Blue Cross Blue Shield	$1,487 - $10,310	160%
Prime Health Services	$2,416 - $13,403	261%
Cigna	$3,717 - $20,620	401%
Friday Health Insurance Company	$4,832 - $26,806	521%
Sana Benefits	$117,621	12693%

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 $7,910.
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 Crescent Medical Center Lancaster 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.