CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Beloit Health System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $955
Cash Discount Price: $336
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Beloit Health System is $955. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $336. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.03x the Medicare baseline. Located in 1969 W Hart Rd, Beloit, WI.

Cash / Self-Pay

$336

Average discount available for prompt cash payment at this facility.

Insurance Median

$955

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: $336 (36%)

Insurance Median: $955 (103%)

Cash: $336 (36% of Medicare)

Ins. Median: $955 (103% 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	$120 - $1,726	13%
Blue Cross Blue Shield	$120 - $3,031	13%
Dean Health	$120 - $4,948	13%
Independent Care Health Plan	$120 - $954	13%
Quartz	$120 - $1,036	13%
UnitedHealthcare	$120 - $2,347	13%
Naphcare	$181 - $1,432	20%
Cook Children'S Health Plan (Cchp)	$314 - $954	34%
Humana	$481 - $3,551	52%
The Alliance	$512 - $3,818	55%
Wps	$542 - $862	58%
Wea Trust	$640 - $999	69%
Multiplan	$931 - $1,454	100%
Managed Health Services	$954	103%
Molina Healthcare	$954	103%
Wellcare	$954	103%
Health Eos	$1,036 - $1,653	112%
Cigna	$1,071 - $1,726	116%
Hfn	$1,071 - $1,726	116%
Preferred Network Access	$1,071 - $1,726	116%

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 $336.
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 Beloit Health System 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.