CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,100
Cash Discount Price: $2,833
vs. Medicare Baseline: 2.27x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at University of Iowa Health Care Medical Center Down is $2,100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,833. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.27x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$2,833

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,100

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: $2,833 (306%)

Insurance Median: $2,100 (227%)

Cash: $2,833 (306% of Medicare)

Ins. Median: $2,100 (227% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 227% of the Medicare baseline (a markup of 127%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$124 - $3,089	13%
Iowa Total Care	$124 - $1,619	13%
Medical Associates	$124 - $2,711	13%
Molina Healthcare	$124 - $1,619	13%
UnitedHealthcare	$124 - $6,174	13%
Blue Cross Blue Shield	$125 - $1,943	13%
Healthpartners	$126 - $3,440	14%
Wellpoint (Amerigroup)	$130 - $926	14%
Quad City Community Healthcare	$471 - $3,035	51%
Immergrun	$654 - $1,012	71%
Aplos Health Plan	$863 - $3,238	93%
Midlands Choice	$962 - $2,631	104%
Oscar Health	$1,647 - $2,550	178%
Great River Health Systems	$1,830 - $2,833	197%
Sedgwick	$2,092 - $3,238	226%
Global Excel	$2,223 - $3,440	240%
Sanford Health Plan	$2,223 - $3,440	240%
Employee Benefit Systems	$2,301 - $3,642	248%
Sisco	$2,301 - $3,561	248%
Healthsmart	$2,354 - $3,642	254%
Hfn	$2,406 - $3,723	260%
Multiplan	$2,406 - $3,723	260%

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 $2,833.
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 University of Iowa Health Care Medical Center Down 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.