Upper endoscopy cost in Houston

• The most expensive hospital charges 8.5× the cheapest for the same code, CPT 43235. Children’s hospitals, and hospitals whose cash price is just their list price, are left out of these figures.
• At 22 of 24 hospitals that publish both, the cash price is lower than the hospital’s median employer-plan rate, which is what a plan member pays in full before meeting the deductible. Cash or insurance?

Outpatient facility charge only. These are the hospital’s own published prices for the facility part of the visit. The doctor’s or radiologist’s fee is billed separately and isn’t included, and your final bill can differ (extra tests, contrast, supplies). Not medical or insurance advice.

Cash price = the hospital’s published “discounted cash price” for self-pay patients. List price = its gross charge. Insurers pay = the rates negotiated with each insurer plan in the same file (employer, marketplace and Medicare Advantage plans). Where a hospital has several lines for the code, the range is shown. Each row shows the date the hospital published its price file. 16 hospitals in the area aren’t listed yet (no file we could read); see data status.

What the price covers

The procedure room and the facility. Anesthesia, the gastroenterologist and pathology are usually billed separately.

Before you book

• Call the hospital’s scheduling or price-estimate line and quote the code: CPT 43235, and ask what the price becomes if a biopsy is taken.
• If you pay cash, ask for the self-pay price in writing (a Good Faith Estimate). Uninsured and self-pay patients have a right to one under the No Surprises Act.
• If you use insurance, check the hospital is in network for your exact plan; your share depends on your deductible and coinsurance. Cash or insurance?

Questions

How much does a upper endoscopy cost in Houston without insurance?

At the 24 Houston hospitals (not counting children’s hospitals) that publish a cash price, the outpatient facility charge for a upper endoscopy (CPT 43235) runs from $426 at Houston Methodist Hospital to $3,619 at St Joseph Medical Center. The doctor’s or radiologist’s fee is extra.

Why do prices differ so much between hospitals?

Each hospital sets its own list price and its own cash discount, and negotiates a different rate with each insurer plan. The same CPT code can cost several times more at one hospital than at another a few miles away.

Is the cash price the final price?

No. It is the hospital’s published discounted cash price for the facility part of the visit. Ask the hospital to confirm it before you book, and ask whether the reading physician bills separately.

Other cities: Dallas–Fort Worth · San Antonio · Austin · McAllen · Miami · Fort Lauderdale · Tampa–St. Petersburg · Jacksonville · all cities