CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Helen Newberry Joy Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $321
Cash Discount Price: $402
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Helen Newberry Joy Hospital is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $402. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.35x the Medicare baseline. Located in 502 W Harrie St, Newberry, MI.

Cash / Self-Pay

$402

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $402 (43%)

Insurance Median: $321 (35%)

Cash: $402 (43% of Medicare)

Ins. Median: $321 (35% 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
Mi Wc - All Plans	$150 - $666	16%
Aetna	$212 - $989	23%
Uphg Tpa - All Plans	$212 - $937	23%
First Health - All Plans	$223 - $989	24%
Ppom/Cofinity - All Plans	$223 - $989	24%
Cigna	$228 - $1,010	25%
Health Alliance - All Plans	$228 - $1,010	25%
Healtheos - All Plans	$228 - $1,010	25%
Priority Health - All Plans	$228 - $1,010	25%
UnitedHealthcare	$228 - $1,010	25%
Vital Core - All Plans	$228 - $1,010	25%
Uphp Mcaid - All Plans	$229	25%
Blue Cross Blue Shield	$232 - $1,028	25%
Va - All Plans	$253	27%
Humana	$321	35%
Mi Health Link - All Plans	$321	35%

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 $402.
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 Helen Newberry Joy 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.