CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Essentia Health St Joseph's Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,398
Cash Discount Price: $2,084
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Essentia Health St Joseph's Medical Center is $1,398. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,084. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.51x the Medicare baseline. Located in 523 North 3Rd Street, Brainerd, MN.

Cash / Self-Pay

$2,084

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,398

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: $2,084 (225%)

Insurance Median: $1,398 (151%)

Cash: $2,084 (225% of Medicare)

Ins. Median: $1,398 (151% 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
Primewest	$874	94%
Itasca Med Care	$938	101%
Medica Access	$978	106%
Advocare/Security Health	$1,007	109%
Blue Cross Blue Shield	$1,007 - $3,351	109%
Freedom Blue Ppo	$1,007	109%
Healthpartners Care Msho / Mcr Adv	$1,007	109%
Imcare Msho Pcc Prime	$1,007	109%
Imcare Msho Ref Req	$1,007	109%
Medica Advantage Solutions	$1,007	109%
Medica Msho/Dual Solutions	$1,007	109%
Medica Prime Solution Group	$1,007	109%
Medicare (plans)	$1,007	109%
Nd Va Administration	$1,007	109%
Platinum Blue/Vantage Blue	$1,007	109%
Primewest Msho	$1,007	109%
Secure Blue Msho	$1,007	109%
Ubh Cost Plan	$1,007	109%
Ubh Msho	$1,007	109%
Ucare Msho	$1,007	109%
UnitedHealthcare	$1,007 - $2,356	109%
Sanford Health Plan	$1,328 - $1,398	143%
Healthpartners Care Pmap	$1,331	144%
Blue Plus Pmap Pcc Prime	$1,393 - $3,129	150%
Medica	$1,969 - $2,189	212%
Medica Uplan	$1,969	212%
Ucare	$2,037	220%
Wea	$2,229 - $2,384	241%
Medica Choice	$2,254	243%
Cigna	$2,276	246%
Healthpartners	$2,276	246%
Healthpartners Pcc Prime	$2,276	246%
America'S Ppo	$2,399	259%
Wps	$2,570 - $2,601	277%
Aetna	$2,632	284%

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 $2,084.
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 Essentia Health St Joseph's Medical Center 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.