CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sycamore Shoals Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$899

about 1.0× the $927 Medicare rate · typically $825–$899

modeled estimate · not a bill or quote

What this hospital charges insurers

$823

About the fair price

about $76 under the fair price · 0.9× Medicare

Medicare pays $927 Fair price $899 This hospital $823 Cash price $385 Hospital's list price $2,564

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

Highest price of the 9 TN hospitals we have prices for — worth calling around.

Cheapest $125 Priciest $823

Black dot = this hospital, among the 9 TN hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $899 (about 1.0× the $927 Medicare rate). Sycamore Shoals Hospital charges insurers about $823, or about $385 in cash — about the fair price. Located in Elizabethton, TN.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$146 - $823	16%
Blue Cross Blue Shieldmajor	$311 - $1,383	34%
Aetnamajor	$823 - $1,636	89%
Cignamajor	$864	93%
Humanamajor	$823	89%
Ambetter (Centene)	$1,794	194%
Amerigroup	$823	89%
Devoted Health	$864	93%
Molina	$856 - $1,439	92%
Sentara	$713 - $1,383	77%
WellCare	$872 - $2,564	94%
+ 3 smaller / regional plans	$823 - $2,564

Government programs also on file: Medicare.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 385), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Sycamore Shoals Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at Sycamore Shoals Hospital

Compare: Upper endoscopy with biopsy at other TN hospitals

Insurance negotiated median for the same procedure, sorted lowest first.