CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Greeneville Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $876
  • Cash Discount Price: $385
  • vs. Medicare Baseline: 0.95x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Greeneville Community Hospital is $876. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $385. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.95x the Medicare baseline. Located in 1420 Tusculum Boulevard, Greeneville, TN.
Cash / Self-Pay
$385

Average discount available for prompt cash payment at this facility.

Insurance Median
$876

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: $385 (42%)
Insurance Median: $876 (95%)
Cash: $385 (42% of Medicare)
Ins. Median: $876 (95% 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.

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
UnitedHealthcare $117 - $1,383 13%
Blue Cross Blue Shield $311 - $1,383 34%
Amerigroup $632 - $880 68%
Sentara Health $662 - $846 71%
Aetna $846 - $1,095 91%
Humana $846 91%
Managed Medicaire $846 91%
Medicare (plans) $846 91%
United Mine Workers Of America $846 91%
Cigna $889 96%
Devoted Health Plan $889 96%
Mountain Empire Pace $889 96%
Nhc Advantage $889 96%
Wellcare $897 - $2,564 97%
Medcost $1,220 132%
Optima Health $1,383 149%
Ambetter / Centene $1,845 199%
First Health Coventry $2,051 221%
Molina Healthcare $2,564 277%
Seven Corners, Inc. $2,564 277%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1420 Tusculum Boulevard, Greeneville, TN 37745
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals