CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: M Health Fairview St John's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,229
Cash Discount Price: $835
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at M Health Fairview St John's Hospital is $1,229. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $835. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.33x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$835

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,229

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: $835 (90%)

Insurance Median: $1,229 (133%)

Cash: $835 (90% of Medicare)

Ins. Median: $1,229 (133% 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
Sanford Health Plan	$56 - $1,230	6%
Security Health Plan	$69 - $1,566	7%
America'S Ppo	$72 - $1,504	8%
First Health	$78 - $1,712	8%
Multiplan	$81 - $1,775	9%
Private Healthcare Systems	$81 - $1,775	9%
Wisconsin Physician Services	$86 - $1,879	9%
Health Partners	$92 - $2,810	10%
Primewest	$92 - $912	10%
South Country Health Alliance	$92 - $912	10%
Ucare	$94 - $2,096	10%
Medica	$99 - $2,264	11%
Blue Cross Blue Shield	$106 - $1,587	11%
Itasca Medical Care	$106 - $912	11%
UnitedHealthcare	$125 - $3,500	13%
Wellcare	$125 - $912	13%
Hennepin Health	$141 - $944	15%

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 $835.
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 M Health Fairview St John's 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.