Skip to main content
States Procedures Methodology Search
CMS Price Transparency Data Hospital file updated: 2026-04-07

Upper endoscopy with biopsy

Facility: Dunes Surgical Hospital

Billing Code: 43239 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
$1,307Fair BaseRate (1.01× Market)
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $1,314 compared to the $1,307 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

The BaseRate · fair price high confidence
A fair price for this
$1,307
about 1.4× the $927 Medicare rate · typically $727–$1,438
modeled estimate · not a bill or quote
What this hospital charges insurers
$1,314
About the fair price
about $7 over the fair price · 1.4× Medicare
Medicare pays $927 Fair price $1,307 This hospital $1,314 Cash price $1,388 Hospital's list price $2,182

How we calculate the fair BaseRate →

How this hospital compares to other SD hospitals

Highest price of the 9 SD hospitals we have prices for — worth calling around.

Cheapest $123 Priciest $1,314

Black dot = this hospital, among the 9 SD hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,307 (about 1.4× the $927 Medicare rate). Dunes Surgical Hospital charges insurers about $1,314, or about $1,388 in cash — about the fair price. Located in Dakota Dunes, SD.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldCigna AetnaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $372 - $1,746 40%
Blue Cross Blue Shieldmajor $944 - $1,526 102%
Cignamajor $1,527 165%
Amerigroup $956 103%
HealthPartners $2,117 228%
Molina $953 103%
Oscar Health $1,101 119%
Sanford Health Plan $1,855 200%
+ 5 smaller / regional plans $925 - $1,855
Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 600 N Sioux Point Road, Dakota Dunes, SD 57049
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals

Other Procedures at Dunes Surgical Hospital

Compare: Upper endoscopy with biopsy at other SD hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Dunes Surgical Hospital (Zero PHI Required)

CMS CCN: 430089
CPT 43239
Fair BaseRate™ $1,307
Medicare Rate $927
Self-Pay Cash $1,388
Insurer Median $1,314
Pre-filled with Dunes Surgical Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $792 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $792

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $792).

Step 2 · Cash vs. Insurance Arbitrage Save $794 Paying Cash

Self-Pay Cash Rate ($1,388) Beats Your Bill

Dunes Surgical Hospital's published 45 CFR § 180 self-pay cash rate is $1,388 (vs. $1,314 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$875 Above Fair BaseRate

Negotiate Toward $1,307 Fair BaseRate ($927 Medicare)

Your bill ($2,182) is $875 above the denoised Fair BaseRate ($1,307) and 2.4× the $927 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 430089

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 430089) ↗ CMS HCRIS Cost Reports ↗
Published MRF File460423353_DunesSurgicalHospital_standardcharges.json
Publication / Vintage2026-04-07 · 24.23 MB
Validated Rate Rows355,220 (CMS v3.0.0)
File Integrity Digest1f7d06384ceb971ab21b…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy