CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Trinity Health Muskegon Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $94
- Cash Discount Price: $4,095
- vs. Medicare Baseline: 0.10x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Trinity Health Muskegon Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,095. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.10x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$4,095
Average discount available for prompt cash payment at this facility.
Insurance Median
$94
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: $4,095 (442%)
Insurance Median: $94 (10%)
Cash: $4,095 (442% of Medicare)
Ins. Median: $94 (10% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $54 - $517 | 6% |
| Aetna | $60 - $949 | 6% |
| Ally Align Care Adv | $60 | 6% |
| American Health Advantage Of Idaho | $60 | 6% |
| American Health Plan | $60 | 6% |
| Aurora Special Needs | $60 | 6% |
| Blue Care Network Advantage | $60 - $949 | 6% |
| Blue Cross Blue Shield | $60 - $977 | 6% |
| Blue Shield - De (Highmark) Medciare Advantage | $60 | 6% |
| Care Dimensions | $60 | 6% |
| Care Improvement Plus | $60 | 6% |
| Care Resources Pace | $60 | 6% |
| Careplus Health Plans | $60 | 6% |
| Cca Senior Care Options | $60 | 6% |
| Central Valley Medical Services Corp Pace | $60 | 6% |
| Champion Health Plan Mcr Advantage | $60 | 6% |
| Cigna | $60 - $115 | 6% |
| Clear Spring Health | $60 | 6% |
| Clover Health | $60 | 6% |
| Commonwealth Care Alliance | $60 | 6% |
| Community Pace At Home | $60 | 6% |
| Eddy Senior Care-Pace | $60 | 6% |
| Eddy Seniorcare Pace | $60 | 6% |
| Elementcare | $60 | 6% |
| Evercare | $60 | 6% |
| Everence | $60 | 6% |
| Gateway Health Plan | $60 | 6% |
| Genesys Pace Of Genesee County | $60 | 6% |
| Georgia Health Advantage | $60 | 6% |
| Gold Advantage | $60 | 6% |
| Gpa Croell Redi Mix | $60 | 6% |
| Health America Advantra | $60 | 6% |
| Highmark Health Options Dual Plan | $60 | 6% |
| Hope Select Pace | $60 | 6% |
| Horizon Nj Total Care | $60 | 6% |
| Hudson Headwaters Pace | $60 | 6% |
| Humana | $60 - $194 | 6% |
| Huron Valley Pace | $60 | 6% |
| Innovative Integrated Health Community Plans | $60 | 6% |
| Iowa Health Advantage | $60 | 6% |
| Johns Hopkins Advantage Md | $60 | 6% |
| Lasso Healthcare Msa | $60 | 6% |
| Life St Marys Pace | $60 | 6% |
| Lifecircles Pace | $60 | 6% |
| Longevity Health Plan | $60 | 6% |
| Martins Point Generations Advantage | $60 | 6% |
| Mass General Brigham Mcr Adv | $60 | 6% |
| Medicare (plans) | $60 - $949 | 6% |
| Medipak Advantage | $60 | 6% |
| Mercy Life | $60 | 6% |
| Mercyone Cedar Valley | $60 | 6% |
| Meridian Complete | $60 | 6% |
| Michigan Complete Health | $60 | 6% |
| Nascentia Health Plus | $60 | 6% |
| New Centry Health Careplus | $60 | 6% |
| Osu Prime Care Advantage | $60 | 6% |
| Pace Cny | $60 | 6% |
| Pace Iowa Immanuel Pathways | $60 | 6% |
| Pace Of Southwest Michigan | $60 | 6% |
| Pace Southeast | $60 | 6% |
| Pace-Trinity Health | $60 | 6% |
| Peak Pace Solutions | $60 | 6% |
| Perennial Advantage | $60 | 6% |
| Preferred Care Partners | $60 | 6% |
| Presbyterian Senior Plan | $60 | 6% |
| Provider Partners Health Plan Of Illinois | $60 | 6% |
| Provider Partners Health Plan Of Indiana | $60 | 6% |
| Pruitthealth Premier | $60 | 6% |
| Reliance Community Care Partners Care Resources Pace | $60 | 6% |
| Rx Allwin | $60 | 6% |
| Rx Grane Grnmedd | $60 | 6% |
| Rx Retiree Rx Care | $60 | 6% |
| Scan Health Plan Mcr Ipa Meritage Oon | $60 | 6% |
| Secure Horizons Ma Pffs | $60 | 6% |
| Serenity Pace | $60 | 6% |
| Siouxland Pace | $60 | 6% |
| Solis Health Plans | $60 | 6% |
| Sunnyview-Pace Finance Dept | $60 | 6% |
| Texan Plus | $60 | 6% |
| The Health Plan | $60 - $194 | 6% |
| Thome Pace | $60 | 6% |
| Todays Options | $60 | 6% |
| Tribute Health Plans | $60 | 6% |
| Um Health Advantage | $60 | 6% |
| Union Health Service | $60 | 6% |
| UnitedHealthcare | $60 - $997 | 6% |
| Welbe Health | $60 | 6% |
| Wellmed | $60 | 6% |
| Align Senior Care | $61 - $968 | 7% |
| Veterans Administration | $61 | 7% |
| Champva | $64 | 7% |
| Tricare | $64 | 7% |
| Triwest Health Alliance | $64 | 7% |
| Us Family Health Plan | $64 | 7% |
| Veterans Eval Services | $64 | 7% |
| Cca - Zing Health | $66 | 7% |
| Access Health | $68 - $678 | 7% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $68 - $1,091 | 7% |
| 1199 National Benefit Fund | $82 | 9% |
| Allied National Global Care | $82 | 9% |
| Asrm - Reliance Standard Life Insurance | $82 | 9% |
| Christian Care Ministry | $82 | 9% |
| Dean Health | $82 | 9% |
| Fallon Health | $82 | 9% |
| Family Life Insurance Company | $82 | 9% |
| International Benefit Administrators | $82 | 9% |
| Lifetime Benefit Solutions | $82 | 9% |
| Manhattan Life | $82 | 9% |
| Molina Marketplace | $82 - $1,258 | 9% |
| Multiplan | $82 | 9% |
| Mvp | $82 | 9% |
| Oscar | $82 - $1,239 | 9% |
| Pai | $82 | 9% |
| Pan-American Life | $82 | 9% |
| Phcs | $82 | 9% |
| Trinity Health Share | $82 | 9% |
| Wellpath | $82 - $1,500 | 9% |
| Partners Direct Health - Brio | $88 | 9% |
| Claimdoc | $94 | 10% |
| Geha | $94 | 10% |
| Kent County Jail | $94 | 10% |
| Muskegon County Jail | $94 | 10% |
| Nomi Health | $94 | 10% |
| Wc Accident Fund | $98 | 11% |
| Wc Advantage | $98 | 11% |
| Wc Aig | $98 | 11% |
| Wc Allied | $98 | 11% |
| Wc Amerisure | $98 | 11% |
| Wc Amtrust | $98 | 11% |
| Wc Asu Risk Mgt | $98 | 11% |
| Wc Berkley Admin | $98 | 11% |
| Wc Broadspire | $98 | 11% |
| Wc Bunch & Associates | $98 | 11% |
| Wc Ccmsi | $98 | 11% |
| Wc Emc Insurance Company | $98 | 11% |
| Wc Esis | $98 | 11% |
| Wc Fcci | $98 | 11% |
| Wc Federated | $98 | 11% |
| Wc Gallagher Bassett | $98 | 11% |
| Wc Genex Care For Ohio | $98 | 11% |
| Wc Guard Insurance Company | $98 | 11% |
| Wc Hartford | $98 | 11% |
| Wc Liberty Mutual | $98 | 11% |
| Wc Meijers | $98 | 11% |
| Wc Michigan | $98 | 11% |
| Wc Mitchell Frankenmuth | $98 | 11% |
| Wc Pma | $98 | 11% |
| Wc Sedgwick | $98 | 11% |
| Wc Sentry | $98 | 11% |
| Wc Travelers | $98 | 11% |
| Wc Tristar | $98 | 11% |
| Wc Walmart | $98 | 11% |
| Wc Zurich | $98 | 11% |
| Andrie Inc | $103 | 11% |
| East Greenbush Central School District | $103 | 11% |
| Genex Wc | $103 | 11% |
| Healthsmart Workers Comp | $103 | 11% |
| Jag Source | $103 | 11% |
| New York State Insurance Fund | $103 | 11% |
| Njm Insurance Group | $103 | 11% |
| Rx Heatlhcomp | $103 | 11% |
| Rx Restat | $103 | 11% |
| Rx Saif Opdp Wc | $103 | 11% |
| Rx Worker'S Comp | $103 | 11% |
| Wc Ace | $103 | 11% |
| Wc Acs Federal Employees | $103 | 11% |
| Wc Acuity | $103 | 11% |
| Wc Aegis | $103 | 11% |
| Wc Aims | $103 | 11% |
| Wc Alaska National Ins | $103 | 11% |
| Wc Align Network | $103 | 11% |
| Wc Am Trust N America | $103 | 11% |
| Wc American Claims Mgmt | $103 | 11% |
| Wc Benetech | $103 | 11% |
| Wc Broward County | $103 | 11% |
| Wc California State Comp Ins | $103 | 11% |
| Wc California State Ins Fund | $103 | 11% |
| Wc Capitol Area Health Consortium | $103 | 11% |
| Wc Chartis | $103 | 11% |
| Wc Chubb | $103 | 11% |
| Wc Cirma | $103 | 11% |
| Wc City Of Albany | $103 | 11% |
| Wc City Of Sioux City | $103 | 11% |
| Wc Claims Mgmt Inc | $103 | 11% |
| Wc Cna | $103 | 11% |
| Wc Comp One Admin C/O Manageability | $103 | 11% |
| Wc Compone Admin | $103 | 11% |
| Wc Corvel | $103 | 11% |
| Wc Ct Healthcare Trust | $103 | 11% |
| Wc Donegal Insurance Group | $103 | 11% |
| Wc Employee Mutual | $103 | 11% |
| Wc Enablecomp | $103 | 11% |
| Wc Encore Health Network | $103 | 11% |
| Wc Erie | $103 | 11% |
| Wc Evolutions | $103 | 11% |
| Wc Fed Ex | $103 | 11% |
| Wc Federal Black Lung | $103 | 11% |
| Wc Finley Occupational Health | $103 | 11% |
| Wc First Agency/Occunet | $103 | 11% |
| Wc Ford Motor | $103 | 11% |
| Wc Fresno Unified Emp | $103 | 11% |
| Wc General Motors | $103 | 11% |
| Wc Generic | $103 | 11% |
| Wc Great West Casualty | $103 | 11% |
| Wc Guarantee Insurance | $103 | 11% |
| Wc Hab | $103 | 11% |
| Wc Hastings | $103 | 11% |
| Wc Health Management | $103 | 11% |
| Wc Heritage Summit | $103 | 11% |
| Wc Hireright | $103 | 11% |
| Wc Horizon | $103 | 11% |
| Wc Icw Group | $103 | 11% |
| Wc Idaho State Ins Fund | $103 | 11% |
| Wc Intercare Insurance | $103 | 11% |
| Wc Intermountain | $103 | 11% |
| Wc Johns Eastern | $103 | 11% |
| Wc Kemberton | $103 | 11% |
| Wc Key Ins & Benefit Solutions | $103 | 11% |
| Wc Mac Risk Management | $103 | 11% |
| Wc Massachusetts | $103 | 11% |
| Wc Mdia | $103 | 11% |
| Wc Meadowbrook Claim | $103 | 11% |
| Wc Medical Administrators | $103 | 11% |
| Wc Memic | $103 | 11% |
| Wc Mercy Workcare | $103 | 11% |
| Wc Michigan Millers Mutual | $103 | 11% |
| Wc Mra | $103 | 11% |
| Wc Nationwide | $103 | 11% |
| Wc Nca Comp | $103 | 11% |
| Wc New York | $103 | 11% |
| Wc New York Special Funds | $103 | 11% |
| Wc North American Rishces | $103 | 11% |
| Wc Northeast Health | $103 | 11% |
| Wc Notre Dame | $103 | 11% |
| Wc Novanet | $103 | 11% |
| Wc O'Hara Corp | $103 | 11% |
| Wc Occ Health Allen | $103 | 11% |
| Wc Ohio Bureau | $103 | 11% |
| Wc One Call Medical | $103 | 11% |
| Wc Paradigm | $103 | 11% |
| Wc Peerless | $103 | 11% |
| Wc Praxis Health Network | $103 | 11% |
| Wc Price Chopper | $103 | 11% |
| Wc Procura Management | $103 | 11% |
| Wc Qualcare | $103 | 11% |
| Wc Quiktrip | $103 | 11% |
| Wc Reny Company | $103 | 11% |
| Wc Rev Claims | $103 | 11% |
| Wc Risico | $103 | 11% |
| Wc Rural Mutual | $103 | 11% |
| Wc Saif Oregon | $103 | 11% |
| Wc Secura | $103 | 11% |
| Wc Sheakley Unicomp | $103 | 11% |
| Wc Smile Lodge | $103 | 11% |
| Wc Society | $103 | 11% |
| Wc Srs | $103 | 11% |
| Wc Taconic (Mro) | $103 | 11% |
| Wc Taconic Farms | $103 | 11% |
| Wc Triad Group | $103 | 11% |
| Wc Troy Ny | $103 | 11% |
| Wc Tyson | $103 | 11% |
| Wc Unified Health Services | $103 | 11% |
| Wc United Heartland | $103 | 11% |
| Wc Us Dept Of Labor | $103 | 11% |
| Wc Velocity | $103 | 11% |
| Wc West Bend | $103 | 11% |
| Wc West Bend Mutual/Argent | $103 | 11% |
| Wc Winnebago Industries | $103 | 11% |
| Wc Yankee Trails | $103 | 11% |
| Wc York Risk | $103 | 11% |
| Wc Zenith | $103 | 11% |
| Blue Care Network | $104 - $977 | 11% |
| Blue Benefit Administrators Of Massachusetts | $109 - $977 | 12% |
| Blue Distinction Transplant | $109 - $977 | 12% |
| Blue Shield - Ca | $109 - $977 | 12% |
| Blue Shield - Id (Regence) | $109 - $977 | 12% |
| Blue Shield - Ny Highmark Northeastern | $109 - $977 | 12% |
| Blue Shield - Ny Highmark Western | $109 - $977 | 12% |
| Blue Shield - Pa (Highmark) | $109 - $977 | 12% |
| Blue Shield - Wa (Regence) | $109 - $977 | 12% |
| Us Health And Life | $112 - $135 | 12% |
| American Postal Workers Secondary | $115 | 12% |
| Priority Health | $122 - $1,889 | 13% |
| Hap | $126 - $183 | 14% |
| Varipro | $126 | 14% |
| Asr Health Benefits | $129 | 14% |
| Bcccp-Michigan | $150 - $168 | 16% |
| U Of M Health Plan | $152 - $754 | 16% |
| Meritain | $159 | 17% |
| Acclaim | $175 - $194 | 19% |
| Administrative Concepts | $175 - $194 | 19% |
| Allegeant | $175 - $194 | 19% |
| Allied Benefit Systems | $175 - $194 | 19% |
| Ameriben | $175 - $194 | 19% |
| American Family | $175 - $194 | 19% |
| American Healthcare Alliance | $175 - $194 | 19% |
| American National | $175 - $194 | 19% |
| American Republic | $175 - $194 | 19% |
| Amerihealth | $175 - $194 | 19% |
| Aultcare | $175 - $194 | 19% |
| Automated Benefit Services | $175 - $194 | 19% |
| Auxiant | $175 - $194 | 19% |
| Benefit Administrative Systems,Llc | $175 - $194 | 19% |
| Boon Chapman | $175 - $194 | 19% |
| Cam Administrative Services | $175 - $194 | 19% |
| Christian Brother Services | $175 - $194 | 19% |
| Christian Brothers Holy Cross | $175 - $194 | 19% |
| Claimchoice Adminstrators | $175 - $194 | 19% |
| Comprehensive Benefits | $175 - $194 | 19% |
| Consociate | $175 - $194 | 19% |
| Continental Life Insurance | $175 - $194 | 19% |
| Coventry | $175 - $194 | 19% |
| Custom Benefit Administrators | $175 - $194 | 19% |
| Cypress Benefit Administrators | $175 - $194 | 19% |
| Employee Benefit Concepts | $175 - $194 | 19% |
| Employee Benefit Management | $175 - $194 | 19% |
| Enterprise Group Planning | $175 - $194 | 19% |
| First Health | $175 - $194 | 19% |
| Forest County Potawatomi | $175 - $194 | 19% |
| Freedom Life Insurance Company | $175 - $194 | 19% |
| Group Administrators | $175 - $194 | 19% |
| Group Marketing Services | $175 - $194 | 19% |
| Group Pension Administrators | $175 - $194 | 19% |
| Guardian | $175 - $194 | 19% |
| Health America | $175 - $194 | 19% |
| Health Choices | $175 - $977 | 19% |
| Health Smart | $175 - $194 | 19% |
| Healthcare Management Admin | $175 - $194 | 19% |
| Healthez | $175 - $194 | 19% |
| Healthgram | $175 - $194 | 19% |
| Healthscope | $175 - $194 | 19% |
| Insight | $175 - $194 | 19% |
| Intercare | $175 - $194 | 19% |
| Jfp Benefit Management | $175 - $194 | 19% |
| Jp Farley Corporation | $175 - $194 | 19% |
| Key Benefit Administrator | $175 - $194 | 19% |
| Liberty Union Life Assurance Co | $175 - $194 | 19% |
| Lucent Health | $175 - $194 | 19% |
| Luminare Health | $175 - $194 | 19% |
| Luminare Health (Detroit) | $175 - $194 | 19% |
| Magnacare | $175 - $194 | 19% |
| Medben | $175 - $194 | 19% |
| Medcost | $175 - $194 | 19% |
| Medical Mutual | $175 - $194 | 19% |
| Mutual Health Services | $175 - $194 | 19% |
| Mutual Of Omaha | $175 - $194 | 19% |
| Ncas | $175 - $194 | 19% |
| Nippon Life Ins | $175 - $194 | 19% |
| Nova | $175 - $194 | 19% |
| Painters Union Insurance Fund | $175 - $194 | 19% |
| Physicians Mutual | $175 - $194 | 19% |
| Plumbers Local 98 Insurance Fund | $175 - $194 | 19% |
| Prairie States | $175 - $194 | 19% |
| Preferred One | $175 - $194 | 19% |
| Primary Physician Care | $175 - $194 | 19% |
| Professional Benefit Administrators | $175 - $194 | 19% |
| Secureone Preferred United Plans | $175 - $194 | 19% |
| Siho Insurance Services | $175 - $194 | 19% |
| Sisco Benefits | $175 - $194 | 19% |
| The Loomis Company | $175 - $194 | 19% |
| Trustmark Small Business Benefits | $175 - $194 | 19% |
| Unicare | $175 - $194 | 19% |
| Unified Group Services | $175 - $194 | 19% |
| Valenz | $175 - $194 | 19% |
| Webtpa | $175 - $194 | 19% |
| Western & Southern Financial Group | $175 - $194 | 19% |
| Wps | $175 - $194 | 19% |
| Health Partners | $183 | 20% |
| Tufts Health Plan | $183 | 20% |
| Correctional Recovery | $968 | 104% |
| Heartland Hospice | $968 | 104% |
| Hospice Harbor Hospice | $968 | 104% |
| Bcn Domestic | $977 | 105% |
| Kaiser Domestic | $977 | 105% |
| Vitalcore | $1,500 | 162% |