CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Memorial Hospital of Lafayette County

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$342

about 0.4× the $927 Medicare rate · typically $121–$2,017

modeled estimate · not a bill or quote

What this hospital charges insurers

$145

Below the fair price — a good deal

about $197 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $342 This hospital $145 Cash price $478 Hospital's list price $598

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

One of the lower prices — 6 of 8 other WI hospitals charge more for the same procedure.

Cheapest $116 Priciest $568

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $342 (about 0.4× the $927 Medicare rate). Memorial Hospital of Lafayette County charges insurers about $145, or about $478 in cash — below the fair price — a good deal. Located in Darlington, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$145 - $302	16%
Blue Cross Blue Shieldmajor	$145 - $302	16%
Aetnamajor	$145 - $389	16%
Humanamajor	$145	16%
Dean Health Plan	$145 - $2,681	16%
Quartz	$145 - $404	16%
+ 3 smaller / regional plans	$145 - $1,359

Government programs also on file: Medicaid.

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 478), 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 Memorial Hospital of Lafayette County 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 Memorial Hospital of Lafayette County

Compare: Upper endoscopy with biopsy at other WI hospitals

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