CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sparrow Ionia Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $582
Cash Discount Price: $276
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sparrow Ionia Hospital is $582. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.63x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$276

Average discount available for prompt cash payment at this facility.

Insurance Median

$582

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: $276 (30%)

Insurance Median: $582 (63%)

Cash: $276 (30% of Medicare)

Ins. Median: $582 (63% 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	$87 - $1,019	9%
Aetna	$184 - $973	20%
Covenant Advantage	$184	20%
Medicare (plans)	$184 - $335	20%
Medigold	$184	20%
Senior Community Care	$184	20%
Humana	$193 - $595	21%
Blue Cross Blue Shield	$218 - $927	24%
Priority	$451	49%
UnitedHealthcare	$564	61%
Cigna	$582	63%
Great West Healthcare	$582	63%
Asr	$588	63%
Blue Care Network	$588	63%
Health Alliance Plan	$588	63%
Cofinity	$595	64%
Mclaren Commercial	$655	71%
Priority Health Medihmo	$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 $276.
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 Sparrow Ionia 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.