CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Bellin Health Oconto Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,357
Cash Discount Price: $2,045
vs. Medicare Baseline: 2.54x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Bellin Health Oconto Hospital is $2,357. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,045. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.54x the Medicare baseline. Located in 820 Arbutus Ave, Oconto, WI.

Cash / Self-Pay

$2,045

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,357

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: $2,045 (221%)

Insurance Median: $2,357 (254%)

Cash: $2,045 (221% of Medicare)

Ins. Median: $2,357 (254% 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 254% of the Medicare baseline (a markup of 154%). 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
Blue Cross Blue Shield	$1,070 - $2,429	115%
Community Care	$1,070	115%
Humana	$1,070	115%
My Choice	$1,070	115%
Network Health	$1,070 - $2,674	115%
UnitedHealthcare	$1,290 - $2,199	139%
Aetna	$1,573	170%
Cigna	$2,224 - $2,262	240%
Common Ground	$2,290 - $2,354	247%
Chorus Community Health Plan	$2,360	255%
Aspirus Arise	$2,463	266%
Healthsmart	$2,517	272%
Ihs(Claimsbridge)	$2,517	272%
Medical College Of Wi	$2,517	272%
Hps/Paymedix	$2,580 - $2,800	278%
Wps Insurance	$2,642	285%
Allied National	$2,674	289%
First Health	$2,674	289%
Galaxy Health	$2,674	289%
Three Rivers Provider Network	$2,831	306%
Trilogy	$2,831	306%

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 $2,045.
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 Bellin Health Oconto Hospital 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.