CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Virginia Gay Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$430

about 0.5× the $927 Medicare rate · typically $158–$823

modeled estimate · not a bill or quote

What this hospital charges insurers

$159

Below the fair price — a good deal

about $271 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $430 This hospital $159 Cash price $946 Hospital's list price $1,182

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

On the higher side — 6 of 8 other IA hospitals charge less.

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 $430 (about 0.5× the $927 Medicare rate). Virginia Gay Hospital charges insurers about $159, or about $946 in cash — below the fair price — a good deal. Located in Vinton, IA.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Humana Blue Cross Blue ShieldAetnaCignaKaiser 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	$115	12%
Humanamajor	$70	8%
+ 3 smaller / regional plans	$117 - $221

Government programs also on file: Medicaid, Military & VA.

Excludes 2 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 946), 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 Virginia Gay Hospital 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 Virginia Gay Hospital

Compare: Upper endoscopy with biopsy at other IA hospitals

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