CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Blount Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,163
Cash Discount Price: $907
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Blount Memorial Hospital is $1,163. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $907. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.26x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$907

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,163

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: $907 (98%)

Insurance Median: $1,163 (126%)

Cash: $907 (98% of Medicare)

Ins. Median: $1,163 (126% 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	$450 - $882	49%
UnitedHealthcare	$450 - $2,481	49%
Prisma Health Seniorcare Pace - Midlands [5400]	$679	73%
Prisma Health Seniorcare Pace-Upstate [5200]	$679	73%
Blue Cross Blue Shield	$853 - $887	92%
Humana	$853	92%
Medicare (plans)	$853 - $887	92%
Tricare	$873	94%
Cigna	$887 - $1,156	96%
Promise Health Plan Contracted [2401]	$1,024 - $1,755	111%
Mvp Health Care [3037]	$1,156	125%
Orangeburg Senior Helping Center Pace [5401]	$1,170	126%
Ambetter / Centene	$1,335	144%
Bob Jones Univ-Pai [821]	$1,755	189%
Consociate Health Contracted [4835]	$1,894	204%
Fairos/Occunet Contracted [4837]	$1,980	214%
Preferred Administrators Contracted [2839]	$2,048	221%
Medcost [2940]	$2,164 - $2,428	234%
Atlantic Packaging Contracted [4833]	$2,194	237%
Aps Healthcare System [2981]	$2,340	253%
Golden Rule Insurance Company [2991]	$2,481	268%
Oxford Health Plans [2992]	$2,481	268%
Multiplan/Phcs Contracted [2950]	$2,603	281%
Aetna	$2,632	284%
Meritain Health Contracted [2200]	$2,632	284%
Nippon [2300]	$2,632	284%
Vsp Vision Care [2986]	$2,632	284%
First Health Contracted [2952]	$2,720	294%
Furman Int/Allen University Student [2951]	$2,720	294%
Quiktrip-First Health [3067]	$2,720	294%

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 $907.
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 Blount Memorial 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.