CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sanford Thief River Falls Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,150
Cash Discount Price: $2,577
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sanford Thief River Falls Medical Center is $2,150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,577. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.32x the Medicare baseline. Located in 3001 Sanford Parkway, Thief River Falls, MN.

Cash / Self-Pay

$2,577

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,150

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: $2,577 (278%)

Insurance Median: $2,150 (232%)

Cash: $2,577 (278% of Medicare)

Ins. Median: $2,150 (232% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 232% of the Medicare baseline (a markup of 132%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Primewest	$984 - $1,353	106%
Ucare	$984 - $2,830	106%
Blue Cross Blue Shield	$1,135 - $2,270	122%
Sanford Health Plan Align	$1,224	132%
Aetna	$1,327 - $2,799	143%
Health Partners	$1,327 - $2,609	143%
Medicare (plans)	$1,327	143%
UnitedHealthcare	$1,327 - $2,690	143%
Sanford Health Plan	$1,726 - $2,030	186%
Security Health Plan	$1,772	191%
Medica	$2,831 - $3,047	306%
Cigna	$2,899	313%
First Choice Health Network	$2,899	313%
Healthez	$2,899	313%
Multiplan	$2,899	313%

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 $2,577.
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 Sanford Thief River Falls Medical Center 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.