CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Audubon County Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,872
Cash Discount Price: $1,810
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Audubon County Memorial Hospital is $1,872. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,810. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.02x the Medicare baseline. Located in 515 Pacific Avenue, Audubon, IA.

Cash / Self-Pay

$1,810

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,872

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: $1,810 (195%)

Insurance Median: $1,872 (202%)

Cash: $1,810 (195% of Medicare)

Ins. Median: $1,872 (202% 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 202% of the Medicare baseline (a markup of 102%). 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	$115 - $2,340	12%
Tricare	$115 - $1,872	12%
Wellmark Hmo	$263 - $2,296	28%
Wellmark Ppo - All Other Plans	$309 - $2,529	33%
UnitedHealthcare	$562 - $2,210	61%
Molina Mcaid - All Plans	$1,020 - $2,600	110%
Iowa Total Care Mcaid - All Plans	$1,030 - $2,626	111%
Amerigroup Mcaid - All Plans	$1,071 - $2,730	116%
Midlands Choice - All Plans	$2,548	275%

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 $1,810.
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 Audubon County 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.