CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Physicians Regional Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$917

about 1.0× the $927 Medicare rate · typically $606–$1,008

modeled estimate · not a bill or quote

What this hospital charges insurers

$998

About the fair price

about $81 over the fair price · 1.1× Medicare

Medicare pays $927 Fair price $917 This hospital $998 Cash price $3,551 Hospital's list price $15,981

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 $998

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $917 (about 1.0× the $927 Medicare rate). Physicians Regional Medical Center charges insurers about $998, or about $3,551 in cash — about the fair price. Located in Powell, 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	$696 - $16,612	75%
Blue Cross Blue Shieldmajor	$834 - $3,223	90%
Aetnamajor	$834 - $1,920	90%
Cignamajor	$1,898 - $1,969	205%
Humanamajor	$810	87%
Ambetter (Centene)	$1,522	164%
Amerigroup	$543 - $850	59%
Cigna HealthSpring	$834	90%
Devoted Health	$826	89%
WellCare	$856	92%
+ 7 smaller / regional plans	$810 - $1,522

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 4 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 3,551), 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 Physicians Regional 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 (%)

Enter your details and press estimate to compare.

Other Procedures at Physicians Regional Medical Center

Compare: Upper endoscopy with biopsy at other TN hospitals

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