CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Lukes Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $435
Cash Discount Price: $914
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Lukes Regional Medical Center is $435. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $914. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.47x the Medicare baseline. Located in 2720 Stone Park Boulevard, Sioux City, IA.

Cash / Self-Pay

$914

Average discount available for prompt cash payment at this facility.

Insurance Median

$435

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: $914 (99%)

Insurance Median: $435 (47%)

Cash: $914 (99% of Medicare)

Ins. Median: $435 (47% 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
Aetna	$124 - $2,292	13%
Blue Cross Blue Shield	$126 - $932	14%
Molina	$126 - $932	14%
Amerivantage	$130 - $959	14%
Humana	$130 - $959	14%
UnitedHealthcare	$130 - $2,502	14%
Avera Health Plan	$185 - $1,965	20%
Wellmark Uph Self-Funded	$263	28%
Health Partners Open Network	$289 - $1,400	31%
Nebraska Total Care	$297	32%
Cigna	$331	36%
Amerigroup	$830	90%
Iowa Total Care	$830	90%

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 $914.
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 St Lukes Regional 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.