CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Madison Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$289

about 0.3× the $927 Medicare rate · typically $130–$1,229

modeled estimate · not a bill or quote

What this hospital charges insurers

$262

About the fair price

about $27 under the fair price · 0.3× Medicare

Medicare pays $927 Fair price $289 This hospital $262 Cash price $612 Hospital's list price $720

How we calculate the fair BaseRate →

How this hospital compares to other MN hospitals

Highest price of the 9 MN hospitals we have prices for — worth calling around.

Cheapest $118 Priciest $262

Black dot = this hospital, among the 9 MN hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $289 (about 0.3× the $927 Medicare rate). Madison Hospital charges insurers about $262, or about $612 in cash — about the fair price. Located in Madison, MN.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$91 - $2,713	10%
Blue Cross Blue Shieldmajor	$91 - $2,713	10%
Aetnamajor	$155 - $662	17%
Humanamajor	$132 - $684	14%
HealthPartners	$86 - $681	9%
Medica	$331 - $612	36%
Sanford Health Plan	$634 - $662	68%
+ 1 smaller / regional plan	$97 - $408

Government programs also on file: Medicare, Medicaid.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 612), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Madison Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Madison Hospital

Compare: Upper endoscopy with biopsy at other MN hospitals

Insurance negotiated median for the same procedure, sorted lowest first.