CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,157

about 1.2× the $927 Medicare rate · typically $470–$1,397

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,155

About the fair price

about $2 under the fair price · 1.2× Medicare

Medicare pays $927 Fair price $1,157 This hospital $1,155 Cash price $8,154 Hospital's list price $8,154

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

Highest price of the 9 MA hospitals we have prices for — worth calling around.

Cheapest $380 Priciest $1,155

Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $1,157 (about 1.2× the $927 Medicare rate). UMass Memorial Healthalliance Hospitals charges insurers about $1,155, or about $8,154 in cash — about the fair price. Located in Leominster, MA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,155 - $3,805	125%
Blue Cross Blue Shieldmajor	$871 - $2,405	94%
Aetnamajor	$1,155 - $2,488	125%
Cignamajor	$1,100 - $4,409	119%
Harvard Pilgrim	$762 - $2,445	82%
Tufts Health Plan	$1,100 - $3,960	119%
+ 12 smaller / regional plans	$294 - $3,805

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 8,154), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm UMass Memorial Healthalliance Hospitals is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UMass Memorial Healthalliance Hospitals

Compare: Upper endoscopy with biopsy at other MA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.