CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Holland Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $348
Cash Discount Price: $284
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Holland Community Hospital is $348. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $284. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.38x the Medicare baseline. Located in 602 Michigan Ave, Holland, MI.

Cash / Self-Pay

$284

Average discount available for prompt cash payment at this facility.

Insurance Median

$348

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: $284 (31%)

Insurance Median: $348 (38%)

Cash: $284 (31% of Medicare)

Ins. Median: $348 (38% 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
UnitedHealthcare	$50 - $498	5%
Nomi Health - All Plans	$84	9%
Life Circles-All Plans	$115	12%
Health Alliance Mcr Adv	$122	13%
Ph Mcr Adv	$122	13%
Va Ccn - All Plans	$122	13%
Aetna	$125 - $560	13%
Longevity Health Plan-All Plans	$131	14%
First Health-All Plans	$158	17%
Benefit Source Inc-All Plans	$212 - $522	23%
Blue Cross Blue Shield	$218	24%
Multiplan - All Plans	$238 - $588	26%
Cigna	$239	26%
Priority Health - All Other Plans	$249	27%
Asr - All Plans	$348	38%
Health Alliance Ahl - All Other Plans	$348	38%
Health Alliance Hmo	$348	38%
Meridian Mcaid Profee Only-All Plans	$498	54%
Molina Mcaid - All Plans	$498	54%
Ph Mcaid	$498	54%
Blue Care Network - All Plans	$550	59%
Cofinity -All Plans	$560	60%
Sisco-All Other Plans	$627	68%
Sisco Epi	$2,284	246%

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 $284.
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 Holland Community Hospital 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.