CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Boone County Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $297
Cash Discount Price: $329
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Boone County Hospital is $297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $329. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.32x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$329

Average discount available for prompt cash payment at this facility.

Insurance Median

$297

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: $329 (36%)

Insurance Median: $297 (32%)

Cash: $329 (36% of Medicare)

Ins. Median: $297 (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
Choice Care Mcr Adv - All Plans	$115	12%
Humana	$115 - $540	12%
Iowa Hlth Adv - All Plans	$115	12%
Mt Carmel Hp - All Plans	$115	12%
Va Ccn-All Plans	$115	12%
Amerigroup Mcr Adv - All Other Plans	$116	13%
Aetna	$117 - $416	13%
UnitedHealthcare	$131 - $201	14%
Healthsmart Accell Network	$132	14%
Health Alliance-All Plans	$138	15%
Healthsmart Ppo - All Other Plans	$138	15%
Tricare	$145 - $240	16%
Medical Associates Hp-All Plans	$219	24%
Wellmark Hmo	$259	28%
Midlands Choice-All Plans	$292	32%
Health Partners Profee Only - All Plans	$302	33%
Wellmark Ppo - All Other Plans	$304	33%
Mutually Preferred-All Plans	$345 - $570	37%
Meridian Mcaid - All Plans	$363 - $600	39%
Iowa Total Care Mcaid - All Plans	$370 - $612	40%
Medicaid / KanCare	$374 - $618	40%

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 $329.
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 Boone County Hospital 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.