CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cass County Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $161
Cash Discount Price: $564
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cass County Memorial Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $564. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.17x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$564

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $564 (61%)

Insurance Median: $161 (17%)

Cash: $564 (61% of Medicare)

Ins. Median: $161 (17% 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
Triwest - All Plans	$112	12%
Aetna	$115 - $724	12%
Amerigroup Mcr Adv - All Other Plans	$115	12%
Medica Mcr Adv	$115	12%
Tricare	$115	12%
UnitedHealthcare	$115 - $214	12%
Va Ccn - All Plans	$115	12%
Wellmark Mcr Adv	$116	13%
Iowa Total Care Mcr	$117	13%
American Hlth Mcr Adv - All Plans	$118	13%
Iowa Total Care Comm - All Other Plans	$127	14%
Midlands Choice Medica Mcr	$161	17%
Wellmark Hmo	$263	28%
Wellmark Ppo - All Other Plans	$310	33%
Midlands Choice New Bus	$325	35%
Midlands Choice Pho (Ppo) - All Other Plans	$325	35%
Medica Comm - All Other Plans	$768	83%
Medicaid / KanCare	$805	87%
Iowa Total Care Mcaid	$821	89%
Multiplan - All Plans	$829	89%
Molina Mcaid - All Plans	$890	96%

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 $564.
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 Cass County Memorial 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.