CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Erlanger Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$402

about 0.4× the $927 Medicare rate · typically $325–$1,183

modeled estimate · not a bill or quote

What this hospital charges insurers

$369

About the fair price

about $33 under the fair price · 0.4× Medicare

Medicare pays $927 Fair price $402 This hospital $369 Cash price $401 Hospital's list price $760

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

A typical price — 5 charge more and 3 charge less, among the 9 TN hospitals compared.

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 $402 (about 0.4× the $927 Medicare rate). Erlanger Medical Center charges insurers about $369, or about $401 in cash — about the fair price. Located in Chattanooga, 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	$127 - $2,871	14%
Blue Cross Blue Shieldmajor	$179 - $860	19%
Aetnamajor	$180 - $886	19%
Cignamajor	$144 - $860	16%
Humanamajor	$179 - $860	19%
Ambetter (Centene)	$224 - $1,075	24%
Amerigroup	$161 - $382	17%
CareSource	$211 - $1,720	23%
Clover Health	$179 - $860	19%
Devoted Health	$186 - $894	20%
UPMC Health Plan	$179 - $860	19%
+ 13 smaller / regional plans	$179 - $2,150

Government programs also on file: Medicare, Medicaid.

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 401), 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 Erlanger Medical Center 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 Erlanger Medical Center

Compare: Upper endoscopy with biopsy at other TN hospitals

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