CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Karmanos Cancer Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $649
Cash Discount Price: $434
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Karmanos Cancer Center is $649. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $434. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.70x the Medicare baseline. Located in 4100 John R, Detroit, MI.

Cash / Self-Pay

$434

Average discount available for prompt cash payment at this facility.

Insurance Median

$649

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: $434 (47%)

Insurance Median: $649 (70%)

Cash: $434 (47% of Medicare)

Ins. Median: $649 (70% 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
Mclaren Commercial Ins	$264	28%
Detroit Medical Center	$302 - $1,658	33%
Priority Health	$512	55%
Medicaid / KanCare	$513 - $574	55%
Interlink Bmt	$573 - $3,145	62%
Phcs-Multiplan	$614 - $3,370	66%
Aetna	$660	71%
Tricare	$827	89%
Humana	$915	99%
Medicare (plans)	$915 - $933	99%
Mi Amish Medical Board	$915	99%
Blue Cross Blue Shield	$990	107%
UnitedHealthcare	$3,640	393%

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 $434.
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 Karmanos Cancer 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.