CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Faulkton Area Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$252

about 0.3× the $927 Medicare rate · typically $131–$1,435

modeled estimate · not a bill or quote

What this hospital charges insurers

$624

Well above the fair price

about $372 over the fair price · 0.7× Medicare

Medicare pays $927 Fair price $252 This hospital $624 Cash price $1,723 Hospital's list price $2,154

How we calculate the fair BaseRate →

How this hospital compares to other SD hospitals

A typical price — 4 charge more and 4 charge less, among the 9 SD hospitals compared.

Cheapest $123 Priciest $966

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 $252 (about 0.3× the $927 Medicare rate). Faulkton Area Medical Center charges insurers about $624, or about $1,723 in cash — well above the fair price. Located in Faulkton, SD.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $252. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Humana AetnaCignaKaiser 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	$376	41%
Blue Cross Blue Shieldmajor	$886	96%
Humanamajor	$136	15%
Medica	$446	48%
+ 2 smaller / regional plans	$803 - $1,007

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,723), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Faulkton Area Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

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

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Faulkton Area Medical Center

Compare: Upper endoscopy with biopsy at other SD hospitals

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