CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: HSHS St Clare Memorial Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$785

about 0.8× the $927 Medicare rate · typically $430–$2,114

modeled estimate · not a bill or quote

What this hospital charges insurers

$613

Below the fair price — a good deal

about $172 under the fair price · 0.7× Medicare

Medicare pays $927 Fair price $785 This hospital $613 Cash price $1,148 Hospital's list price $1,739

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $116 Priciest $613

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $785 (about 0.8× the $927 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $613, or about $1,148 in cash — below the fair price — a good deal. Located in Oconto Falls, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$133	14%
Blue Cross Blue Shieldmajor	$133 - $1,566	14%
Aetnamajor	$133 - $1,739	14%
Cignamajor	$1,087	117%
Humanamajor	$133 - $1,478	14%
Health Net	$1,043	113%
Meridian	$1,566	169%
Molina	$133 - $1,660	14%
Security Health Plan	$134 - $1,110	14%
+ 16 smaller / regional plans	$845 - $1,739

Government programs also on file: Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,148), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm HSHS St Clare Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at HSHS St Clare Memorial Hospital

Compare: Upper endoscopy with biopsy at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.