CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $288
Cash Discount Price: $771
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Iowa Specialty Hospital - Clarion is $288. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $771. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.31x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$771

Average discount available for prompt cash payment at this facility.

Insurance Median

$288

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: $771 (83%)

Insurance Median: $288 (31%)

Cash: $771 (83% of Medicare)

Ins. Median: $288 (31% 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
Tricare	$115	12%
Triwest Va - All Plans	$115	12%
Aetna	$134	14%
Healthscope Stellar-All Plans	$190	21%
Wellmark Hmo	$249	27%
Cigna	$288	31%
Midlands Choice-All Plans	$288	31%
Wellmark Ppo - All Other Plans	$302	33%
Health Partners Ish-All Other Plans	$313	34%
UnitedHealthcare	$345	37%
Auxiant Clarion Schools-All Plans	$835	90%
Health Partners Prestage	$964	104%

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 $771.
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 Iowa Specialty Hospital - Clarion 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.