Upper GI endoscopy with biopsy at Trinity Health Livonia Hospital. CPT 43239.
What Trinity Health Livonia Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$6,083cash price (self-pay)
—list price
$95.32–$2,034range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Medicaid | Molina Medicaid | $118 |
| Philadelphia County Funding | Medicaid | $118 |
| Kaiser Permanente Medicaid Advantage | Medicaid | $118 |
| Blue Cross - Dc (Carefirst) Medicaid Advantage | Medicaid | $118 |
| Affinity Health Plan Medicaid Advantage | Medicaid | $118 |
| Community Benefit Health | Medicaid | $118 |
| Blue Cross - NY (Anthem) Medicaid Advantage | Medicaid | $118 |
| Medicaid - Ks | Medicaid | $118 |
| Medicaid - Ia | Medicaid | $118 |
| Medicaid - In | Medicaid | $118 |
| Mclaren Health Medicaid | Mclaren Medicaid | $123 |
| Champva | Tricare | $177 |
| Rx Allwin | Medicare | $203 |
| Priority Health Medicare Advantage | Priority Health Medicare Advantag | $203 |
| Hap Medicare Advantage | Hap Medicare Advantage | $203 |
| Molina Medicare Advantage | Molina Medicare Advantage | $203 |
| Blue Cross - Mi Medicare Advantage | BCBS Medicare Advantage | $203 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $203 |
| Blue Care Network Advantage | Bcn Medicare Advantage | $203 |
| Total Healthcare Medicare Snp | Medicare | $203 |
| Connecticare Vip Medicare | Medicare | $203 |
| Aetna Medicare Assure Premier HMO D-Snp | Medicare | $203 |
| Anthem Mycare Ohio | Medicare | $203 |
| Optum Medicare Transplant | Medicare | $203 |
| Sunnyview-Pace Finance Dept | Medicare | $203 |
| Eddy Senior Care-Pace | Medicare | $203 |
| Highmark Health Options Dual Plan | Medicare | $203 |
| Champion Health Plan Mcr Advantage | Medicare | $203 |
| Longevity Ipa Of Michigan LLC Health Plan Isnp | Longevity Ipa Medicar | $233 |
| Wc Compone Admin | Workers Comp | $266 |
Inpatient
—cash price (self-pay)
$301list price
$43.67–$283range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid - Wy | Medicaid | $43.67 |
| Medicaid Oos Nhi | Medicaid | $43.67 |
| Breast Grant-Connecticut | Medicaid | $43.67 |
| Pace Of Southwest Michigan | Medicaid | $43.67 |
| Maryland Breast & Cervical Program | Medicaid | $43.67 |
| Oregon Screenwise | Medicaid | $43.67 |
| Screening For Life | Medicaid | $43.67 |
| Medicaid - NY Ssl | Medicaid | $43.67 |
| Rx Allwin | Medicare | $62.96 |
| Genesys Pace Of Genesee County | Medicare | $62.96 |
| Community Pace At Home | Medicare | $62.96 |
| Medicare Alternate Payor | Medicare | $62.96 |
| Veterans Administration | Veterans Affairs | $64.24 |
| Christian Care Ministry | Multiplan | $86.73 |
| Dean Health | Multiplan | $86.73 |
| Family Life Insurance Company | Multiplan | $86.73 |
| Phcs | Multiplan | $86.73 |
| Cigna | Priority Health Cigna | $98.96 |
| Wc Generic | Workers Comp | $103 |
| Aetna | Aetna | $159 |
| Meritain | Aetna | $159 |
| Luminare Health | Cofinity | $169 |
| Administrative Concepts | Cofinity | $169 |
| Coventry | Cofinity | $169 |
| Allied Benefit Systems | Cofinity | $169 |
| American Family | Cofinity | $169 |
| American Republic | Cofinity | $169 |
| Custom Benefit Administrators | Cofinity | $169 |
| Comprehensive Benefits | Cofinity | $169 |
| Employee Benefit Management | Cofinity | $169 |
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