CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Covenant Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $391
Cash Discount Price: $247
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Covenant Medical Center is $391. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $247. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.42x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$247

Average discount available for prompt cash payment at this facility.

Insurance Median

$391

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: $247 (27%)

Insurance Median: $391 (42%)

Cash: $247 (27% of Medicare)

Ins. Median: $391 (42% 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
Health Advantage Mclaren Employee	$159	17%
Priority Health E	$162	17%
Aetna	$192 - $927	21%
Physicians Health Plan	$194	21%
Priority Health	$194 - $927	21%
Blue Care Network	$218 - $985	24%
Blue Cross Blue Shield	$218 - $985	24%
Humana	$265 - $927	29%
Meritain Health	$270	29%
Mclaren Health Advantage	$277	30%
Multiplan	$318	34%
Health Alliance Plan Of Michigan	$391 - $1,788	42%
Healthy Michigan Mclaren	$391 - $485	42%
Healthy Michigan Meridian	$391 - $485	42%
Healthy Michigan Molina	$391 - $485	42%
Healthy Michigan Priority Health	$391 - $485	42%
Mclaren Advantage	$391 - $927	42%
Molina Healthplan	$391 - $927	42%
Physicians Health Plan Advantage/Advantage Plus	$391 - $927	42%

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 $247.
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 Covenant Medical Center 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.