CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kossuth Regional Health Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,121
Cash Discount Price: $1,647
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Kossuth Regional Health Center is $1,121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,647. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.21x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$1,647

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,121

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: $1,647 (178%)

Insurance Median: $1,121 (121%)

Cash: $1,647 (178% of Medicare)

Ins. Median: $1,121 (121% 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
Humana	$115 - $1,163	12%
Va Ccn - All Plans	$115 - $1,151	12%
Amerigroup Mcr Adv - All Other Plans	$117 - $1,174	13%
UnitedHealthcare	$118 - $2,300	13%
Mercy One - All Plans	$121 - $1,151	13%
Sanford Pho Isno Mcr Adv Profee Only - All Plans	$121	13%
Medical Associates - All Plans	$190 - $2,576	21%
Preferred Health - All Plans	$190 - $2,576	21%
Blue Cross Blue Shield	$263 - $1,342	28%
Health Partners New Bus - All Other Plans	$299 - $2,121	32%
Midlands Choice - All Plans	$321 - $2,121	35%
Health Partners Exisiting Bus	$329 - $2,939	36%
Aetna	$687 - $2,939	74%
Multiplan - All Plans	$1,034 - $2,878	112%
Molina Mcaid/Chip - All Plans	$1,115 - $3,121	120%
Amerigroup Mcaid	$1,121 - $3,151	121%

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 $1,647.
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 Kossuth Regional Health 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.