CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mobridge Regional Hospital - Cah

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,093
Cash Discount Price: $2,314
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mobridge Regional Hospital - Cah is $1,093. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,314. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.18x the Medicare baseline. Located in 1401 10Th Ave West, Mobridge, SD.

Cash / Self-Pay

$2,314

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,093

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: $2,314 (250%)

Insurance Median: $1,093 (118%)

Cash: $2,314 (250% of Medicare)

Ins. Median: $1,093 (118% 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
Medica Mcare Advan	$118 - $1,041	13%
UnitedHealthcare	$118 - $2,243	13%
Avera/Dakotacare-All Plans	$287 - $2,657	31%
Wellmark Indem/Ppo-All Plans	$322 - $2,136	35%
Medica Mn Health Care	$1,093 - $1,605	118%
Medica Msho Mcare	$1,093 - $1,605	118%
Medica Comm-All Other Plans	$1,605 - $2,328	173%
Sanford Healthplan-All Plans	$2,657	287%

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 $2,314.
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 Mobridge Regional Hospital - Cah 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.