CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Johnson County Community Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$714

about 0.8× the $927 Medicare rate · typically $218–$1,346

modeled estimate · not a bill or quote

What this hospital charges insurers

$589

Below the fair price — a good deal

about $125 under the fair price · 0.6× Medicare

Medicare pays $927 Fair price $714 This hospital $589 Cash price $377 Hospital's list price $1,641

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

On the higher side — 7 of 8 other TN hospitals charge less.

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 $714 (about 0.8× the $927 Medicare rate). Johnson County Community Hospital charges insurers about $589, or about $377 in cash — below the fair price — a good deal. Located in Mountain City, 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	$171 - $1,425	18%
Blue Cross Blue Shieldmajor	$311 - $1,425	34%
Aetnamajor	$476 - $1,439	51%
Cignamajor	$500	54%
Humanamajor	$484	52%
Ambetter (Centene)	$525	57%
Amerigroup	$476 - $543	51%
Devoted Health	$500	54%
Molina	$495 - $1,439	53%
Sentara	$476 - $1,383	51%
WellCare	$476	51%
+ 3 smaller / regional plans	$476 - $1,641

Government programs also on file: Medicare.

Excludes 2 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 377), 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 Johnson County Community 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 Johnson County Community Hospital

Compare: Upper endoscopy with biopsy at other TN hospitals

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