CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Essentia Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,656
Cash Discount Price: $2,322
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Essentia Health is $1,656. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,322. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.79x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.

Cash / Self-Pay

$2,322

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,656

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: $2,322 (251%)

Insurance Median: $1,656 (179%)

Cash: $2,322 (251% of Medicare)

Ins. Median: $1,656 (179% 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
Medica Access	$830	90%
Primewest	$874	94%
Advocare/Security Health	$938	101%
Blue Cross Blue Shield	$938 - $2,090	101%
Freedom Blue Ppo	$938	101%
Healthpartners Care Msho / Mcr Adv	$938	101%
Imcare Msho Pcc Prime	$938	101%
Imcare Msho Ref Req	$938	101%
Itasca Med Care	$938	101%
Medica Advantage Solutions	$938	101%
Medica Msho/Dual Solutions	$938	101%
Medica Prime Solution Group	$938	101%
Medicare (plans)	$938	101%
Nd Va Administration	$938	101%
Platinum Blue/Vantage Blue	$938	101%
Primewest Msho	$938	101%
Secure Blue Msho	$938	101%
Ubh Cost Plan	$938	101%
Ubh Msho	$938	101%
Ucare Msho	$938	101%
UnitedHealthcare	$938 - $2,468	101%
Healthpartners Care Pmap	$1,204	130%
Sanford Health Plan	$1,328 - $1,660	143%
Medica	$1,715 - $1,907	185%
Medica Uplan	$1,715	185%
Medica Choice	$1,963	212%
Ucare	$2,037	220%
Cigna	$2,074	224%
Healthpartners	$2,074	224%
Healthpartners Pcc Prime	$2,074	224%
Wea	$2,229 - $2,384	241%
America'S Ppo	$2,399	259%
Wps	$2,570 - $2,601	277%
Aetna	$2,632	284%

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 $2,322.
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 Essentia 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.