CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Shenandoah Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $298
Cash Discount Price: $629
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Shenandoah Medical Center is $298. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $629. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.32x the Medicare baseline. Located in 300 Pershing Avenue, Shenandoah, IA.

Cash / Self-Pay

$629

Average discount available for prompt cash payment at this facility.

Insurance Median

$298

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: $629 (68%)

Insurance Median: $298 (32%)

Cash: $629 (68% of Medicare)

Ins. Median: $298 (32% 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
UnitedHealthcare	$98 - $968	11%
Triwest Wellmark - All Plans	$114	12%
Aetna	$115	12%
Molina Mcr - All Other Plans	$115	12%
Tricare	$115	12%
Wellcare Mcr Adv - All Plans	$115	12%
Midlands Choice-All Plans	$286	31%
Blue Cross Blue Shield	$310	33%
Home State Health Plan Mcaid-All Plans	$968	104%
Molina Mcd	$968	104%
Nebraska Total Care Mcaid-All Plans	$968	104%
Iowa Total Care Mcaid-All Plans	$978	106%
Amerigroup Mcaid-All Plans	$987	107%

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 $629.
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 Shenandoah Medical 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.