CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Unitypoint Health - Meriter

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $906
Cash Discount Price: $1,414
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Unitypoint Health - Meriter is $906. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,414. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.98x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$1,414

Average discount available for prompt cash payment at this facility.

Insurance Median

$906

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: $1,414 (153%)

Insurance Median: $906 (98%)

Cash: $1,414 (153% of Medicare)

Ins. Median: $906 (98% 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
Aspirus	$124 - $2,656	13%
Blue Cross Blue Shield	$124 - $4,205	13%
Illinicare	$124 - $906	13%
Prevea 360	$124 - $3,763	13%
UnitedHealthcare	$124 - $5,169	13%
Humana	$131 - $906	14%
Meridiancare	$131 - $906	14%
Cigna	$199 - $1,328	21%
Security Health Plan	$213 - $1,372	23%
Mercy Care	$248 - $1,470	27%
Health Partners Open Network	$289 - $1,616	31%
Medical Associates Health Plan	$413 - $1,594	45%
Wellmark Uph Self-Funded	$415 - $3,937	45%
Quartz	$1,381	149%

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 $1,414.
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 Unitypoint Health - Meriter 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.