CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Metro Nashville General Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $125
Cash Discount Price: $1,654
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Metro Nashville General Hospital is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,654. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.13x the Medicare baseline. Located in 1818 Albion Street, Nashville, TN.

Cash / Self-Pay

$1,654

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $1,654 (178%)

Insurance Median: $125 (13%)

Cash: $1,654 (178% of Medicare)

Ins. Median: $125 (13% 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	$69 - $125	7%
Corizon	$82	9%
Amerigroup	$109	12%
Amerivantage	$109	12%
Aetna	$125 - $1,516	13%
Blue	$125	13%
Cigna	$125 - $158	13%
Humana	$125	13%
Medicare (plans)	$125	13%
Upmc	$125	13%
Wellcare	$125	13%
Farm Bureau	$127	14%
Corecivic	$137	15%
Ambetter / Centene	$175	19%
Naphcare	$187	20%
Provider Network Of America	$212	23%
Blue Cross Blue Shield	$363 - $479	39%

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 $1,654.
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 Metro Nashville General Hospital 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.