CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Anne's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,568
Cash Discount Price: $4,694
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Anne's Hospital is $1,568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,694. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.69x the Medicare baseline. Located in 795 Middle Street, Fall River, MA.

Cash / Self-Pay

$4,694

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,568

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: $4,694 (507%)

Insurance Median: $1,568 (169%)

Cash: $4,694 (507% of Medicare)

Ins. Median: $1,568 (169% 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
UnitedHealthcare	$750 - $1,168	81%
Aetna	$1,087 - $3,190	117%
Commonwealth Care Alliance	$1,141	123%
Fallon Health Community Care	$1,304 - $1,576	141%
Blue Cross Blue Shield	$1,568	169%
Senior Whole Health	$1,630	176%
Tufts Health Plan	$1,951	211%
Harvard Pilgrim Health Care	$3,712	401%

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 $4,694.
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 Saint Anne's Hospital 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.