CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Perham Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $511
Cash Discount Price: $930
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Perham Health is $511. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $930. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.55x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$930

Average discount available for prompt cash payment at this facility.

Insurance Median

$511

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: $930 (100%)

Insurance Median: $511 (55%)

Cash: $930 (100% of Medicare)

Ins. Median: $511 (55% 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 Mn Special Needs Basic Care Dual	$88 - $511	9%
Ucare Mn Medical Assistance	$97 - $515	10%
Ucare Mn Minnesota Care	$97 - $515	10%
Ucare Mn Senior Care Plus	$97 - $515	10%
Ucare Mn Special Needs Basic Care	$97 - $515	10%
Blue Cross Blue Shield	$118 - $2,270	13%
Health Partners Mcr Adv	$118 - $487	13%
Humana	$118 - $487	13%
Medicare (plans)	$118 - $572	13%
Medica Mcr Adv	$136 - $487	15%
Ucare Individual And Family Plan-All Other Plans	$140 - $716	15%
UnitedHealthcare	$150 - $1,431	16%
Ucare Mn Senior Health Options	$487 - $716	53%
Medicaid / KanCare	$516 - $1,474	56%
Medica Mcaid Mn Care	$524	57%
Medica Mn (Msho)	$590	64%
Sanford Health Plan-All Plans	$650 - $1,216	70%
Health Partners Minnesota Care	$716	77%
Medica Mn Senior Hp/Outside Mn	$730	79%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$787 - $1,073	85%
Medica Commercial-All Other Plans	$1,047	113%
Health Partners-All Plans	$1,173	127%
Preferred One (Ppo)	$1,216	131%

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 $930.
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 Perham 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.