CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Waverly Health Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$209

about 0.2× the $927 Medicare rate · typically $126–$810

modeled estimate · not a bill or quote

What this hospital charges insurers

$115

Below the fair price — a good deal

about $94 under the fair price · 0.1× Medicare

Medicare pays $927 Fair price $209 This hospital $115 Cash price $612 Hospital's list price $1,177

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

Lowest price of the 9 IA hospitals we have prices for — a strong deal.

Cheapest $115 Priciest $178

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $209 (about 0.2× the $927 Medicare rate). Waverly Health Center charges insurers about $115, or about $612 in cash — below the fair price — a good deal. Located in Waverly, IA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$104 - $960	11%
Blue Cross Blue Shieldmajor	$263	28%
Aetnamajor	$836 - $1,164	90%
+ 4 smaller / regional plans	$115 - $952

Government programs also on file: Medicare.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 612), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Waverly Health Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Waverly Health Center

Compare: Upper endoscopy with biopsy at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.