CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Munson Healthcare Grayling Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$249

about 0.3× the $927 Medicare rate · typically $179–$699

modeled estimate · not a bill or quote

What this hospital charges insurers

$193

Below the fair price — a good deal

about $56 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $249 This hospital $193

How we calculate the fair BaseRate →

How this hospital compares to other MI hospitals

On the higher side — 7 of 8 other MI hospitals charge less.

Cheapest $118 Priciest $204

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

A fair price for a Upper endoscopy with biopsy is about $249 (about 0.3× the $927 Medicare rate). Munson Healthcare Grayling Hospital charges insurers about $193 — below the fair price — a good deal. Located in Grayling, MI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$87 - $904	9%
Blue Cross Blue Shieldmajor	$47 - $963	5%
Aetnamajor	$122 - $904	13%
Cignamajor	$249 - $1,731	27%
Humanamajor	$122 - $904	13%
Meridian	$87 - $473	9%
Molina	$87 - $976	9%
Priority Health	$87 - $1,731	9%
WellCare	$122 - $904	13%
+ 11 smaller / regional plans	$87 - $904

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, 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 Munson Healthcare Grayling Hospital 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 (%)

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Other Procedures at Munson Healthcare Grayling Hospital

Compare: Upper endoscopy with biopsy at other MI hospitals

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