CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lonesome Pine Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,080

about 1.2× the $927 Medicare rate · typically $933–$1,519

modeled estimate · not a bill or quote

What this hospital charges insurers

$929

Below the fair price — a good deal

about $151 under the fair price · 1.0× Medicare

Medicare pays $927 Fair price $1,080 This hospital $929 Cash price $385 Hospital's list price $2,564

How we calculate the fair BaseRate →

How this hospital compares to other VA hospitals

Highest price of the 9 VA hospitals we have prices for — worth calling around.

Cheapest $813 Priciest $929

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

A fair price for a Upper endoscopy with biopsy is about $1,080 (about 1.2× the $927 Medicare rate). Lonesome Pine Hospital charges insurers about $929, or about $385 in cash — below the fair price — a good deal. Located in Big Stone Gap, VA.

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	$106 - $1,316	11%
Blue Cross Blue Shieldmajor	$311 - $2,564	34%
Aetnamajor	$885 - $1,329	96%
Cignamajor	$929	100%
Humanamajor	$885	96%
Ambetter (Centene)	$1,929	208%
Amerigroup	$885	96%
Devoted Health	$929	100%
Molina	$929 - $1,342	100%
Sentara	$649 - $1,318	70%
WellCare	$938	101%
+ 4 smaller / regional plans	$885 - $2,124

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 385), 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 Lonesome Pine 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 Lonesome Pine Hospital

Compare: Upper endoscopy with biopsy at other VA hospitals

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