CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lakewood Health System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $299
Cash Discount Price: $964
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Lakewood Health System is $299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $964. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.32x the Medicare baseline. Located in 49725 County Road 83, Staples, MN.

Cash / Self-Pay

$964

Average discount available for prompt cash payment at this facility.

Insurance Median

$299

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: $964 (104%)

Insurance Median: $299 (32%)

Cash: $964 (104% of Medicare)

Ins. Median: $299 (32% 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
Ucare Msho/Special Needs	$86 - $1,143	9%
Blue Cross Blue Shield	$118 - $3,458	13%
Humana	$118 - $1,121	13%
Ucare Mcr Adv	$118 - $1,143	13%
UnitedHealthcare	$118 - $2,469	13%
Medica Msho/Mcr Adv	$132 - $1,110	14%
Ucare Individual/Family - All Other Plans	$155 - $1,276	17%
Medica Choice Care	$164 - $1,354	18%
Medica Choice/Focus/Ifb/Mhps - All Other Plans	$225 - $2,483	24%
Preferred One Hmo	$257 - $2,635	28%
Preferred One Ppo - All Other Plans	$273 - $2,635	29%
Health Partners - All Plans	$316 - $2,608	34%

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 $964.
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 Lakewood Health System 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.