CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Astera Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $357
Cash Discount Price: $806
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Astera Health is $357. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $806. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.39x the Medicare baseline. Located in 421 11Th Street Nw, Wadena, MN.

Cash / Self-Pay

$806

Average discount available for prompt cash payment at this facility.

Insurance Median

$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: $806 (87%)

Insurance Median: $357 (39%)

Cash: $806 (87% of Medicare)

Ins. Median: $357 (39% 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 Pmap [30006]	$96 - $2,576	10%
Blue Plus Pmap [40002]	$98 - $1,760	11%
Health Partners Pmap [10046]	$98 - $3,560	11%
Medica Pmap [10057]	$98 - $2,640	11%
Primewest Pmap [30003]	$98 - $2,640	11%
UnitedHealthcare	$182 - $5,471	20%
Health Partners [10045]	$221 - $5,061	24%
Medica Nonpmap [10056]	$235 - $86,929	25%
Blue Cross Blue Shield	$296 - $3,520	32%
Primewest Non Pmap [30004]	$357	39%
Ucare Non Pmap [30007]	$357 - $2,973	39%
Sanford Health Plan [10120]	$537 - $593	58%
Ucare Commercial [10705]	$830 - $5,262	90%
Multiplan	$893 - $5,662	96%
Aetna	$1,004 - $6,370	108%

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 $806.
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 Astera 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.