CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Brookings Health System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $230
Cash Discount Price: $592
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Brookings Health System is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $592. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.25x the Medicare baseline. Located in 300 22Nd Ave, Brookings, SD.

Cash / Self-Pay

$592

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $592 (64%)

Insurance Median: $230 (25%)

Cash: $592 (64% of Medicare)

Ins. Median: $230 (25% 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
Medicare (plans)	$131 - $230	14%
Medica	$230	25%
Medica_Accessibility_Solution	$230	25%
Medica_Choice_Care	$230	25%
Medica_Msho	$230	25%
Medica_Selectcare	$230	25%
Avera	$279	30%
Blue Cross Blue Shield	$317	34%
Medicaid / KanCare	$376	41%
Sanford_Bhcag	$418	45%
Multiplan	$946	102%
UnitedHealthcare	$1,011	109%

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 $592.
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 Brookings Health System 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.