CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lonesome Pine Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $929
Cash Discount Price: $385
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Lonesome Pine Hospital is $929. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $385. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.00x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$385

Average discount available for prompt cash payment at this facility.

Insurance Median

$929

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: $385 (42%)

Insurance Median: $929 (100%)

Cash: $385 (42% of Medicare)

Ins. Median: $929 (100% 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	$106 - $1,316	11%
Blue Cross Blue Shield	$311 - $2,564	34%
Sentara Health	$649 - $885	70%
Aetna	$885 - $1,329	96%
Amerigroup	$885	96%
Humana	$885	96%
Managed Medicaire	$885	96%
Medicare (plans)	$885	96%
United Mine Workers Of America	$885	96%
Cigna	$929	100%
Devoted Health Plan	$929	100%
Molina Healthcare	$929 - $1,342	100%
Mountain Empire Pace	$929	100%
Nhc Advantage	$929	100%
Wellcare	$938	101%
Medcost	$1,220	132%
Optima Health	$1,318	142%
Ambetter / Centene	$1,929	208%
Seven Corners, Inc.	$2,124	229%
First Health Coventry	$2,308	249%

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 $385.
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 Lonesome Pine 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.