CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: University of Michigan Health - West

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $497
Cash Discount Price: $264
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at University of Michigan Health - West is $497. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $264. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.54x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$264

Average discount available for prompt cash payment at this facility.

Insurance Median

$497

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: $264 (28%)

Insurance Median: $497 (54%)

Cash: $264 (28% of Medicare)

Ins. Median: $497 (54% 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	$156 - $497	17%
Priority Health	$290	31%
Web Tpa	$290	31%
Aetna	$443	48%
Alliance Health & Life Ppo	$443	48%
Asr Physicians	$443	48%
Hap	$443	48%
Golden Rule Ins	$477	51%
Medica	$477	51%
Student Ins/Mega Life	$477	51%
UnitedHealthcare	$477	51%
Humana	$496 - $927	54%
Molina Healthcare Of Mi	$497	54%
Asr Cofinity	$552	60%
Cofinity Commercial	$552	60%
Cofinity Weyco	$552	60%
Core Source	$552	60%
Epoch Group	$552	60%
Health Partners	$552	60%
Hlthcomp Admin	$552	60%
Mid America	$552	60%
Care Resources	$834	90%
Insight Metro Care	$927	100%
Medicare (plans)	$927	100%
Molina Marketplace Commercial	$927	100%

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 $264.
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 University of Michigan Health - West 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.