Upper endoscopy with biopsy
Facility: Oakleaf Surgical Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $898
- Cash Discount Price: $2,498
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $898 - $2,245 | 97% |
| Dean Health Plan | $898 | 97% |
| Group Health Cooperative Of Eau Claire | $898 | 97% |
| Healthpartners | $898 | 97% |
| Humana | $898 | 97% |
| Medica | $898 | 97% |
| Quartz Health Solutions | $898 | 97% |
| Security Health Plan Of Wi | $898 - $2,471 | 97% |
| Ucare Wi | $898 | 97% |
| UnitedHealthcare | $898 | 97% |
| Alliance | $1,700 | 183% |
Consumer Guidance & Cost Commentary
Oakleaf Surgical Hospital, located at 1000 Oakleaf Way in Altoona, Wisconsin, performed an upper endoscopy with biopsy during the 2026-06 vintage. The facility's cash median rate is $2,498, while the negotiated rates for in-network payers range from a low of $898 to a high of $2,471, with a median negotiated rate of $898. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, patients with high-deductible plans or those who have met their deductible may find paying the cash price of $2,498 more cost-effective than relying on insurance, especially if their plan's negotiated rate is higher than the cash amount. The Medicare benchmarking rate for this service is $926.63, which serves as a reliable baseline for evaluating the true cost of care at this facility.
For patients seeking to minimize costs, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can significantly reduce the final bill. Since over 80% of hospital bills contain errors, patients should request a full itemized, CPT-coded bill before agreeing to any payment terms to identify unbundled codes or services not rendered. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network emergency services at in-network facilities, patients should remain vigilant against signing consent waivers that waive these protections for non-emergency procedures. Finally, if a patient receives a summary bill, they must demand a detailed line-by-line statement to ensure accuracy, as summary bills often obscure