CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercyone North Iowa Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $927
Cash Discount Price: $17,157
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mercyone North Iowa Medical Center is $927. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,157. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.00x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$17,157

Average discount available for prompt cash payment at this facility.

Insurance Median

$927

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: $17,157 (1852%)

Insurance Median: $927 (100%)

Cash: $17,157 (1852% of Medicare)

Ins. Median: $927 (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
Iowa Dept Of Public Health	$70	8%
Iowa Total Care	$878	95%
Medicaid / KanCare	$886 - $890	96%
Bcn Domestic	$927	100%
Blue Benefit Administrators Of Massachusetts	$927	100%
Blue Care Network	$927	100%
Blue Cross Blue Shield	$927 - $968	100%
Blue Distinction Transplant	$927	100%
Blue Shield - Ca	$927	100%
Blue Shield - Id (Regence)	$927	100%
Blue Shield - Ny Highmark Northeastern	$927	100%
Blue Shield - Ny Highmark Western	$927	100%
Blue Shield - Pa (Highmark)	$927	100%
Blue Shield - Wa (Regence)	$927	100%
Kaiser Domestic	$927	100%
Pre-Employment	$927	100%
Wc Domestic	$927	100%
Aetna	$958	103%
Medicare (plans)	$958 - $997	103%
UnitedHealthcare	$977	105%
Centivo	$1,202	130%
Oscar	$1,289	139%
Amish Hospital Aid	$1,300	140%
Ambetter / Centene	$1,642	177%
Claimdoc	$1,965	212%
Nova	$1,965	212%

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 $17,157.
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 Mercyone North Iowa Medical Center 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.