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Upper GI endoscopy with biopsy at Henry Ford Providence Southfield Hospital. CPT 43239.

What Henry Ford Providence Southfield Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.

Outpatient / ER

—cash price (self-pay)
—list price
$392–$1,268range insurers pay
Insurance planNegotiated rate
Molina Health | 1081_sjpk,Sjpr Medicaid Replacement Molina Health Inpa$392
Hap Alliance Health | 1212_sjpk,Sjpr Ahlic 20241001$399
Hap HMO POS | 1217_sjpk,Sjpr Hap HMO 20241001$399
Hap Preferred | 1210_sjpk,Sjpr Hap Preferred 20241001$471
Blue Caid Michigan | 1266_sjpk,Sjpr Medicaid Replacement Blue Caid Of $533
Great Lakes- UHC Community Plan | 1247_sjpk,Sjpr Medicaid Replacement $533
Harbor Health Mcd | 1243_sjpr Medicaid Repleacement Harbor Health Outp$533
Health Plan Of Mi Medicaid HMO | 1262_sjpk,Sjpr Medicaid Replacement M$533
Jvhl - Medicaid Replacement | 1245_sjpk,Sjpr Medicaid Replacement HMO $533
Medicaid | 1263_sjpk,Sjpr Mi Medicaid Outpatient 20250101$533
Medicaid Replacement | 1242_sjpr Medicaid HMO Outpatient 20250101$533
Molina Health | 1264_sjpk,Sjpr Medicaid Replacement Molina Health Outp$533
Omnicare Medicaid HMO | 1244_sjpr Medicaid Repleacement Omnicare Outpa$533
Total Health Care | 1246_sjpk,Sjpr Medicaid Replacement Total Health C$533
Bc Metro Detroit EPO | 1127_sjpr Blue Cross Blue Shield Metro Detroit $748
Bc Metro Detroit HMO | 1133_sjpr Blue Cross Blue Shield Metro Detroit $748
Bcn Local Network Southeast | 1131_sjpr Blue Cross Blue Shield Bcn Loc$748
Blue Care Network | 1129_sjpr Blue Cross Blue Shield Bcn 20220401$748
Blue Cross PPO | 1137_sjpr Blue Cross Blue Shield PPO 20220401$748
Blue Cross Traditional | 1135_sjpr Blue Cross Blue Shield Of Michigan $748
Amerihealth Vip Care Mcr | 1254_sjpk,Sjpr Medicare Advantage Ameriheal$790
Aetna Medicare | 1255_sjpk,Sjpr Medicare Advantage Aetna Outpatient 20$919
Auto Insurance | 1257_sjpk,Sjpr Auto Insurance Outpatient 20250101$919
Jvhl - Mcr Replacement | 1251_sjpk,Sjpr Medicare Advantage Jvhl Outpat$919
Mcr Replacement | 1253_sjpk,Sjpr Medicare Advantage HMO Outpatient 202$919
Veterans Choice | 1256_va Optum Health Outpatient 20250101$919
Humana Mcr | 1252_sjpk,Sjpr Medicare Advantage Humana Outpatient 20250$928
Meridian Wellcare | 1250_sjpk,Sjpr Medicare Advantage Meridian Wellcar$965
Molina Advantage | 1249_sjpk,Sjpr Medicare Advantage Molina Outpatient$965
Meridian Ambetter | 1258_sjpk,Sjpr Meridian Ambetter Outpatient 202501$1,148

Inpatient

—cash price (self-pay)
—list price
$533–$1,268range insurers pay
Insurance planNegotiated rate
Amerihealth Vip Care Mcr | 1174_sjpk,Sjpr Medicare Advantage Ameriheal$909
Aetna Medicare | 1171_sjpk,Sjpr Medicare Advantage Aetna Inpatient 202$919
Auto Insurance | 1219_sjpk,Sjpr Auto Insurance Inpatient 20241001$919
Health Plan Of Mi Medicaid HMO | 1083_sjpk,Sjpr Meridian Health Inpati$919
Jvhl - Mcr Replacement | 1180_sjpk,Sjpr Medicare Advantage Jvhl Inpati$919
Jvhl - Medicaid Replacement | 1079_sjpk,Sjpr Medicaid HMO Jvhl Inpatie$919
Mcr Replacement | 1183_sjpk,Sjpr Medicare Advantage HMO Inpatient 2024$919
Veterans Choice | 1230_va Optum Health Inpatient 20241001$919
Humana Mcr | 1177_sjpk,Sjpr Medicare Advantage Humana Inpatient 202410$928
Meridian Wellcare | 1189_sjpk,Sjpr Medicare Advantage Meridian Wellcar$965
Molina Advantage | 1192_sjpk,Sjpr Medicare Advantage Molina Inpatient $965
Meridian Ambetter | 1221_sjpk,Sjpr Meridian Ambetter Inpatient 2024100$1,148
Molina Marketplace | 1223_sjpk,Sjpr Molina Marketplace Inpatient 20241$1,148
Smart Health | 1227_sjpk,Sjpr Smart Health Inpatient 20241001$1,268
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All common services at Henry Ford Providence Southfield Hospital