CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,919
Cash Discount Price: $1,578
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Gundersen Moundview Hospital and Clinics is $1,919. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,578. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.07x the Medicare baseline. Located in 402 W Lake St, Friendship, WI.

Cash / Self-Pay

$1,578

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,919

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: $1,578 (170%)

Insurance Median: $1,919 (207%)

Cash: $1,578 (170% of Medicare)

Ins. Median: $1,919 (207% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 207% of the Medicare baseline (a markup of 107%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerigroup	$433	47%
Blue Cross Blue Shield	$1,061 - $5,142	115%
Health Partners	$1,061 - $3,395	115%
Security Health Plan	$1,061 - $1,769	115%
Ucare	$1,061 - $3,076	115%
Quartz	$1,257 - $2,096	136%
Wps	$1,778 - $2,964	192%
Wps - Arise	$1,778 - $2,964	192%
Dean Health Plan	$1,834 - $3,057	198%
Aspirus Arise Health	$1,915 - $3,191	207%
Humana	$1,961 - $3,268	212%
Multiplan/Healtheos	$2,030 - $3,691	219%
Coventry Health Care	$2,192 - $3,653	237%
UnitedHealthcare	$2,781	300%
Alliance	$3,076 - $3,653	332%
Iowa Total Care	$3,101	335%
Managed Health Service	$3,101	335%

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 $1,578.
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 Gundersen Moundview Hospital and Clinics 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.