CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Veterans Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,727
Cash Discount Price: $2,290
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Veterans Memorial Hospital is $1,727. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,290. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.86x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.

Cash / Self-Pay

$2,290

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,727

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: $2,290 (247%)

Insurance Median: $1,727 (186%)

Cash: $2,290 (247% of Medicare)

Ins. Median: $1,727 (186% 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
Amerigroup Mcaid - All Other Plans	$927	100%
Wellmark Hmo - All Other Plans	$1,067	115%
Wellmark Ppo	$1,172	126%
Amerigroup Mcr Adv	$1,727	186%
Humana	$1,727 - $3,013	186%
Iowa Total Care Exchange	$1,727	186%
Iowa Total Care Mcr Adv	$1,727	186%
Medica Mcr Adv	$1,727	186%
Molina Mcr Adv	$1,727	186%
Quartz Mcr Adv	$1,727	186%
UnitedHealthcare	$1,727 - $3,414	186%
Welmark Mcr Adv	$1,727	186%
Iowa Total Care Mcaid - All Other Plans	$2,049	221%
Molina Mcaid - All Other Plans	$2,049	221%
Aetna	$2,683	290%
Quartz Comm - All Other Plans	$3,013	325%
Medica Comm - All Other Plans	$3,198	345%

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 $2,290.
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 Veterans Memorial Hospital 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.