CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UW Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $435
Cash Discount Price: $196
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UW Health is $435. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $196. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.47x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$196

Average discount available for prompt cash payment at this facility.

Insurance Median

$435

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: $196 (21%)

Insurance Median: $435 (47%)

Cash: $196 (21% of Medicare)

Ins. Median: $435 (47% 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
Aetna	$125 - $2,551	13%
Blue Cross Blue Shield	$125 - $1,748	13%
Humana	$125 - $927	13%
Medicare (plans)	$125 - $1,019	13%
Mychoice Wi Medical Adv	$125 - $927	13%
UnitedHealthcare	$125 - $2,716	13%
Medicaid / KanCare	$134	14%
Cigna	$242 - $2,820	26%
Quartz Fully Insured	$264 - $1,226	28%
Alliance Premier Network	$281 - $1,929	30%
Quartz Aso	$298 - $1,930	32%
The Alliance	$302 - $2,483	33%
Ecoh	$320 - $2,782	35%
Hfn	$320 - $2,782	35%
Wps	$614	66%
Beloit Healt System	$712 - $3,189	77%
Mercy Care	$859	93%
Workers Comp	$897	97%
Wps Ppo	$2,733	295%
Mercycare	$3,299	356%
First Health/Coventry	$3,475	375%
Health Payment Systems	$4,124	445%
Healthsmart	$4,124	445%
Sheboygan Employers Health Network	$4,398	475%
Multiplan	$4,915	530%

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 $196.
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 UW Health 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.