CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Connecticut Childrens Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,731
Cash Discount Price: $1,237
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Connecticut Childrens Medical Center is $1,731. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,237. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.87x the Medicare baseline. Located in 282 Washington Street, Hartford, CT.

Cash / Self-Pay

$1,237

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,731

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: $1,237 (133%)

Insurance Median: $1,731 (187%)

Cash: $1,237 (133% of Medicare)

Ins. Median: $1,731 (187% 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
Harvard Pilgrim [1001134]	$1,504 - $1,731	162%
Multiplan [1001126]	$1,504 - $1,752	162%
UnitedHealthcare	$1,504 - $1,850	162%
Cigna	$1,537	166%
Great West Healthcare [100107]	$1,537	166%
Health Partners [110229]	$1,537	166%
Mvp Health Plan [100144]	$1,537	166%
Tufts Health Plan [100114]	$1,537	166%
Blue Cross Blue Shield	$1,557	168%
Unicare [100148]	$1,557	168%
Wellpoint [100150]	$1,557	168%
Aetna	$1,560 - $1,733	168%
Golden Rule [100106]	$1,731	187%
Oxford [100103]	$1,731	187%
1199 National Benefit Fund [100134]	$1,733	187%
Government Employees Hospital Assoc [100115]	$1,733	187%
Humana	$1,733	187%
Meritain Health [100149]	$1,733	187%
Nippon Life Ins Co Of America [100112]	$1,733	187%
Yale Health Plan [100162]	$1,733	187%
Cdphp/Comm [100199]	$1,752	189%
Generic Multiplan [1001130]	$1,752	189%
Ultrabenefits/Comm [100181]	$1,752	189%
Connecticare [100105]	$1,753 - $1,850	189%
Emblem Health Commercial [1001108]	$1,850	200%
Medicaid / KanCare	$1,850	200%

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 $1,237.
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 Connecticut Childrens Medical Center 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.