CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Rhea Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$558

about 0.6× the $927 Medicare rate · typically $207–$1,355

modeled estimate · not a bill or quote

What this hospital charges insurers

$258

Below the fair price — a good deal

about $300 under the fair price · 0.3× Medicare

Medicare pays $927 Fair price $558 This hospital $258 Cash price $548 Hospital's list price $806

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

One of the lower prices — 7 of 8 other TN hospitals charge more for the same procedure.

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 $558 (about 0.6× the $927 Medicare rate). Rhea Medical Center charges insurers about $258, or about $548 in cash — below the fair price — a good deal. Located in Dayton, TN.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ Blue Cross Blue Shield✓ Cigna✓ Humana UnitedHealthcareAetnaKaiser 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
Blue Cross Blue Shieldmajor	$133 - $1,500	14%
Cignamajor	$560 - $1,200	60%
Humanamajor	$132 - $475	14%

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 548), 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 Rhea 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 Rhea Medical Center

Compare: Upper endoscopy with biopsy at other TN hospitals

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