CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: McLaren Macomb

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$529

about 0.6× the $927 Medicare rate · typically $206–$964

modeled estimate · not a bill or quote

What this hospital charges insurers

$218

Below the fair price — a good deal

about $311 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $529 This hospital $218 Cash price $1,395 Hospital's list price $2,789

How we calculate the fair BaseRate →

How this hospital compares to other MI hospitals

Highest price of the 9 MI hospitals we have prices for — worth calling around.

Cheapest $118 Priciest $218

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $529 (about 0.6× the $927 Medicare rate). McLaren Macomb charges insurers about $218, or about $1,395 in cash — below the fair price — a good deal. Located in Mount Clemens, MI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$222	24%
Blue Cross Blue Shieldmajor	$218 - $1,640	24%
Aetnamajor	$174	19%
Humanamajor	$122 - $914	13%
Priority Health	$208 - $1,564	22%
+ 4 smaller / regional plans	$132 - $914

Government programs also on file: Medicare, Medicaid, Military & VA.

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 (about 1,395), 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 McLaren Macomb 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 (%)

Enter your details and press estimate to compare.

Other Procedures at McLaren Macomb

Compare: Upper endoscopy with biopsy at other MI hospitals

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