CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Thomas Highlands Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$905

about 1.0× the $927 Medicare rate · typically $808–$1,164

modeled estimate · not a bill or quote

What this hospital charges insurers

$885

About the fair price

about $20 under the fair price · 1.0× Medicare

Medicare pays $927 Fair price $905 This hospital $885 Cash price $1,093 Hospital's list price $3,644

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 $885

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 $905 (about 1.0× the $927 Medicare rate). Saint Thomas Highlands Hospital charges insurers about $885, or about $1,093 in cash — about the fair price. Located in Sparta, 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	$885	96%
Blue Cross Blue Shieldmajor	$885 - $929	96%
Aetnamajor	$903	97%
Cignamajor	$1,185 - $2,984	128%
Humanamajor	$885	96%
Ambetter (Centene)	$1,150	124%
Amerigroup	$885	96%
Cigna HealthSpring	$885	96%
Oscar Health	$1,239	134%
+ 6 smaller / regional plans	$373 - $1,239

Government programs also on file: Medicare.

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 1,093), 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 Saint Thomas Highlands Hospital 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 Saint Thomas Highlands Hospital

Compare: Upper endoscopy with biopsy at other TN hospitals

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