CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sanford Usd Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,189
Cash Discount Price: $2,540
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sanford Usd Medical Center is $1,189. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,540. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.28x the Medicare baseline. Located in 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD.

Cash / Self-Pay

$2,540

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,189

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: $2,540 (274%)

Insurance Median: $1,189 (128%)

Cash: $2,540 (274% of Medicare)

Ins. Median: $1,189 (128% 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
Sanford Health Plan	$136	15%
Blue Cross Blue Shield	$402 - $1,140	43%
Sanford Health Plan Align	$891	96%
Primewest	$950 - $984	103%
Ucare	$950 - $2,232	103%
Aetna	$966 - $2,429	104%
Health Partners	$966 - $1,238	104%
Medicare (plans)	$966	104%
UnitedHealthcare	$966 - $2,797	104%
Security Health Plan	$1,746	188%
Medica	$2,140 - $2,289	231%
First Choice Health Network	$2,858	308%
Healthez	$2,858	308%
Multiplan	$2,858	308%

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 $2,540.
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 Usd 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.