CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Manning Regional Healthcare Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,406
Cash Discount Price: $1,364
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Manning Regional Healthcare Center is $1,406. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,364. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.52x the Medicare baseline. Located in 1550 Sixth Street, Manning, IA.

Cash / Self-Pay

$1,364

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,406

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: $1,364 (147%)

Insurance Median: $1,406 (152%)

Cash: $1,364 (147% of Medicare)

Ins. Median: $1,406 (152% 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
Medical Associates Mcr	$115 - $2,251	12%
Medicare (plans)	$115 - $2,251	12%
Merigold Mcr Adv-All Plans	$115 - $2,251	12%
Tricare	$115 - $2,251	12%
UnitedHealthcare	$115 - $3,120	12%
Oscar Epo-All Plans	$199 - $3,377	21%
Medical Associates Comm-All Other Plans	$219 - $2,412	24%
Preferred Health - All Plans	$219 - $2,412	24%
Wellmark Hmo	$257 - $2,167	28%
Wellmark Ppo-All Other Plans	$257 - $2,385	28%
Midlands Choice- All Plans	$281 - $3,152	30%
Aetna	$416 - $3,152	45%
Iowa Total Care Mcaid-All Plans	$639 - $2,395	69%
Medicaid / KanCare	$645 - $2,418	70%

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 $1,364.
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 Manning Regional Healthcare 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.