CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Charlevoix Area Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $126
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Charlevoix Area Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.14x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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%)

Insurance Median: $126 (14%)

Ins. Median: $126 (14% 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
Blue Cross Blue Shield	$47 - $640	5%
Mclaren Health Plan	$87 - $640	9%
Meridian	$87 - $640	9%
Priority Health	$87 - $640	9%
UnitedHealthcare	$87 - $640	9%
Aetna	$122	13%
Blue Care Network	$122	13%
Hap (Health Alliance Plan)	$122 - $1,362	13%
Medicare (plans)	$122	13%
Michigan Amish Medical Board	$122	13%
Molina	$122	13%
Northern Michigan Mennonite Group	$122	13%
Asr Physicians Care Network	$182	20%
Nomi Health	$194	21%
Employee Benefits Logistics	$207	22%
Cigna	$249	27%
Provider Network Of America/Hma Group Health	$1,271	137%

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 $X.
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 Charlevoix Area 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.