CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Upland Hills Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,373
Cash Discount Price: $1,541
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Upland Hills Health is $1,373. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,541. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.48x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$1,541

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,373

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: $1,541 (166%)

Insurance Median: $1,373 (148%)

Cash: $1,541 (166% of Medicare)

Ins. Median: $1,373 (148% 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
Humana	$123 - $3,392	13%
Dean Health Plan	$237 - $3,346	26%
UnitedHealthcare	$351 - $566	38%
Alliance	$568 - $2,131	61%
Blue Cross Blue Shield	$1,055 - $3,091	114%
Icare	$1,055	114%
Medical Associates	$1,055 - $2,827	114%
Mhs	$1,055 - $1,373	114%
Security Health Plan	$1,055	114%
Ghc Of Eau Claire	$1,373	148%
Ghc Of Sc Wi	$1,373 - $2,563	148%
Wps	$2,299 - $2,371	248%
Quartz	$2,601	281%
Cigna	$2,812 - $3,144	303%
Multiplan	$3,317	358%

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 $1,541.
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 Upland Hills Health 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.