CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Shenandoah Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$266

about 0.3× the $927 Medicare rate · typically $126–$1,193

modeled estimate · not a bill or quote

What this hospital charges insurers

$310

Above the fair price

about $44 over the fair price · 0.3× Medicare

Medicare pays $927 Fair price $266 This hospital $310 Cash price $629 Hospital's list price $968

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 $310

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

A fair price for a Upper endoscopy with biopsy is about $266 (about 0.3× the $927 Medicare rate). Shenandoah Medical Center charges insurers about $310, or about $629 in cash — above the fair price. Located in Shenandoah, IA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $266. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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	$98 - $968	11%
Blue Cross Blue Shieldmajor	$310	33%
Aetnamajor	$115	12%
Amerigroup	$987	107%
Molina	$115 - $968	12%
WellCare	$115	12%
+ 3 smaller / regional plans	$968 - $978

Government programs also on file: Military & VA.

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 629), 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 Shenandoah Medical 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 Shenandoah Medical Center

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.