CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Washington County Hospital and Clinics

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$266

about 0.3× the $927 Medicare rate · typically $143–$868

modeled estimate · not a bill or quote

What this hospital charges insurers

$230

Below the fair price — a good deal

about $36 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $266 This hospital $230 Cash price $743 Hospital's list price $990

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

Highest price of the 9 IA hospitals we have prices for — worth calling around.

Cheapest $115 Priciest $230

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 $266 (about 0.3× the $927 Medicare rate). Washington County Hospital and Clinics charges insurers about $230, or about $743 in cash — below the fair price — a good deal. Located in Washington, 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

✓ Blue Cross Blue Shield✓ Aetna✓ Humana UnitedHealthcareCignaKaiser 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
Blue Cross Blue Shieldmajor	$125 - $990	13%
Aetnamajor	$132 - $230	14%
Humanamajor	$126	14%
Ambetter (Centene)	$301	32%
HealthPartners	$121 - $302	13%
Molina	$118	13%
WellCare	$127	14%
+ 5 smaller / regional plans	$124 - $990

Government programs also on file: Medicaid.

Excludes 1 rental-network / third-party entry (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 743), 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 Washington County Hospital and Clinics 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 Washington County Hospital and Clinics

Compare: Upper endoscopy with biopsy at other IA hospitals

Waverly Health Center · Waverly $115
Mahaska Health Partnership · Oskaloosa $115
Guthrie County Hospital · Guthrie Center $117
Story County Hospital · Nevada $124
Cass County Memorial Hospital · Atlantic $127
Clarke County Hospital · Osceola $142
Virginia Gay Hospital · Vinton $159
Winnmed · Decorah $164

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