CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Erlanger Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $372
Cash Discount Price: $401
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Erlanger Medical Center is $372. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $401. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.40x the Medicare baseline. Located in 975 E 3Rd St, Chattanooga, TN.

Cash / Self-Pay

$401

Average discount available for prompt cash payment at this facility.

Insurance Median

$372

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: $401 (43%)

Insurance Median: $372 (40%)

Cash: $401 (43% of Medicare)

Ins. Median: $372 (40% 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
UnitedHealthcare	$127 - $2,871	14%
Cigna	$144 - $860	16%
Amerigroup	$161 - $382	17%
Alexian	$179 - $860	19%
Blue Cross Blue Shield	$179 - $860	19%
Bluecare	$179 - $894	19%
Clover	$179 - $860	19%
Humana	$179 - $860	19%
Medicare (plans)	$179	19%
Upmc	$179 - $860	19%
Aetna	$180 - $886	19%
Pruitthealth Premier	$183	20%
American Health	$184 - $886	20%
Devoted Health	$186 - $894	20%
Nhc	$188 - $903	20%
Atrio Health	$197 - $946	21%
Simpra Advantage	$197	21%
Caresource	$211 - $1,720	23%
Peach State Hlth Plan	$211	23%
Ambetter / Centene	$224 - $1,075	24%
Bluecard - Network S	$224 - $381	24%
Bluecard - Network P	$238 - $381	26%
Caresource Ga	$251 - $450	27%
Caresource Tn	$251 - $450	27%
Olympus	$268 - $304	29%
Alliant	$286 - $813	31%
Caresource Nc	$303 - $450	33%
Occunet	$313 - $817	34%
Point Comfort Underwriters	$314 - $322	34%
Pnoa	$320 - $2,150	35%
Wellpoint	$774	84%

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 $401.
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 Erlanger Medical Center 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.