CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: University Health System, Inc

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $856
Cash Discount Price: $518
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at University Health System, Inc is $856. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $518. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.92x the Medicare baseline. Located in 1924 Alcoa Highway, Knoxville, TN.

Cash / Self-Pay

$518

Average discount available for prompt cash payment at this facility.

Insurance Median

$856

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: $518 (56%)

Insurance Median: $856 (92%)

Cash: $518 (56% of Medicare)

Ins. Median: $856 (92% 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
Humana	$109 - $856	12%
UnitedHealthcare	$124 - $1,691	13%
Wellcare	$124	13%
Aetna	$126 - $1,451	14%
Blue Cross Blue Shield	$127 - $1,428	14%
Cigna	$127 - $1,666	14%
Nhc	$127 - $907	14%
American Health	$130 - $907	14%
Signature	$131	14%
Wellpoint	$131 - $907	14%
Devoted Health	$133 - $890	14%
Nx Health 2	$208	22%
Choicecare	$216 - $429	23%
Novanet	$298 - $569	32%
Bluecare	$313 - $333	34%
Tenncare	$333	36%
Initial Group	$445	48%
Coventry	$450 - $1,750	49%
Multiplan	$450 - $1,244	49%
First Health	$495	53%
Beechstreet	$521 - $1,555	56%
Nx Health 1	$546	59%
Fentress County Sheriffs Dept	$829	89%
Wellcare-Windsor Medadv	$899	97%
Medicare (plans)	$907 - $916	98%
Nx Health	$1,244	134%
Phcs	$1,244	134%
Naphcare	$1,348	145%
Prime Health	$1,555 - $2,074	168%
Seven Corners	$1,555	168%
Usa	$1,659	179%
Evolutions	$1,866	201%
Galaxy	$1,866	201%
Healthsmart	$1,866	201%

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 $518.
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 University Health System, Inc 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.