CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sanford Clear Lake Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$341

about 0.4× the $927 Medicare rate · typically $139–$2,341

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,270

Well above the fair price

about $1,929 over the fair price · 2.4× Medicare

Medicare pays $927 Fair price $341 This hospital $2,270 Cash price $2,578 Hospital's list price $3,222

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 $2,270

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 $341 (about 0.4× the $927 Medicare rate). Sanford Clear Lake Medical Center charges insurers about $2,270, or about $2,578 in cash — well above the fair price. Located in Clear Lake, 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 $341. 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.

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser 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	$1,791 - $2,690	193%
Blue Cross Blue Shieldmajor	$1,775 - $2,803	192%
Aetnamajor	$1,791 - $2,800	193%
Cignamajor	$2,900	313%
Health Net	$2,900	313%
HealthPartners	$1,791 - $2,416	193%
Medica	$2,658 - $2,842	287%
Sanford Health Plan	$1,653 - $2,996	178%
Security Health Plan	$1,772	191%
UCare	$1,775 - $2,831	192%
+ 2 smaller / regional plans	$1,827 - $2,900

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 2,578), 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 Sanford Clear Lake 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 Sanford Clear Lake Medical Center

Compare: Upper endoscopy with biopsy at other SD hospitals

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