CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,155
Cash Discount Price: $8,154
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UMass Memorial Healthalliance Hospitals is $1,155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,154. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.25x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$8,154

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,155

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: $8,154 (880%)

Insurance Median: $1,155 (125%)

Cash: $8,154 (880% of Medicare)

Ins. Median: $1,155 (125% 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	$56 - $2,328	6%
Hsno/Free Care [10801]	$294	32%
Workers Compensation [20501]	$380 - $1,251	41%
Fallon Connectorcare [10503]	$506 - $2,737	55%
Harvard Pilgrim [10701]	$762	82%
Blue Cross Blue Shield	$871 - $2,405	94%
Champva [11001]	$1,002 - $2,028	108%
Cigna	$1,100 - $4,409	119%
Correctional Care [11003]	$1,100 - $2,328	119%
Institution [10406]	$1,100 - $2,328	119%
Medicare (plans)	$1,100 - $2,328	119%
Tufts Dual [10111]	$1,100 - $2,328	119%
Tufts Us Family [11203]	$1,100 - $2,328	119%
Aetna	$1,155 - $2,488	125%
Commonwealth Care Mcr [10115]	$1,155 - $2,445	125%
Fallon Mcr Supp [20202]	$1,155 - $2,445	125%
Harvard Pilgrim Mcr [10106]	$1,155 - $2,445	125%
Mgb Mcr [10124]	$1,155 - $2,445	125%
Tufts Mcr [10112]	$1,155 - $2,445	125%
UnitedHealthcare	$1,155 - $3,805	125%
Senior Whole Health [10110]	$1,177 - $2,491	127%
Wellpoint [11112]	$1,508	163%
Tufts [11201]	$1,509	163%
Tufts Connectorcare [10507]	$1,872 - $3,960	202%
Hne [11108]	$2,123	229%
First Health Network [11120]	$2,854	308%
Multiplan [11109]	$2,854	308%
Connecticare [11105]	$3,805	411%
Fallon Carelon Hlth [28]	$3,805	411%
Fallon Mcaid Carelon Hlth [29]	$3,805	411%
Grants [20507]	$3,805	411%

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 $8,154.
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 UMass Memorial Healthalliance Hospitals 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.