CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: McLaren Oakland

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $450
Cash Discount Price: $1,042
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at McLaren Oakland is $450. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,042. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.49x the Medicare baseline. Located in 50 N Perry St, Pontiac, MI.

Cash / Self-Pay

$1,042

Average discount available for prompt cash payment at this facility.

Insurance Median

$450

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: $1,042 (112%)

Insurance Median: $450 (49%)

Cash: $1,042 (112% of Medicare)

Ins. Median: $450 (49% 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
Medicaid / KanCare	$87 - $538	9%
Humana	$122 - $914	13%
Medicare (plans)	$122 - $1,463	13%
Hap - Hmo	$132	14%
U Of M Health Plan	$140	15%
Aetna	$174	19%
Priority Health	$208	22%
Blue Cross Blue Shield	$218 - $1,457	24%
UnitedHealthcare	$222	24%
Mclaren Commercial Ins	$277	30%
Tricare	$827	89%
Mi Amish Medical Board	$914	99%

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 $1,042.
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 McLaren Oakland 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.