CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Boston Medical Center-Brighton

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,087
Cash Discount Price: $889
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Boston Medical Center-Brighton is $1,087. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $889. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.17x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$889

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,087

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: $889 (96%)

Insurance Median: $1,087 (117%)

Cash: $889 (96% of Medicare)

Ins. Median: $1,087 (117% 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
Hsn Bad Debt [4003]	$475	51%
Hsn Confidential [4007]	$475	51%
Hsn Dental [4006]	$475	51%
Hsn Partial [4002]	$475	51%
Hsn [4001]	$475	51%
Harvard Pilgrim Health Care [8001]	$745	80%
Blue Cross Blue Shield	$871 - $1,087	94%
Unicare [8004]	$1,011	109%
Wellpoint [2034]	$1,011	109%
Aetna	$1,087 - $1,445	117%
Humana	$1,087	117%
Medicare (plans)	$1,087 - $1,141	117%
Neighborhood Pace [1206]	$1,087	117%
Senior Whole Health [1210]	$1,087	117%
Ubh Hphc [8016]	$1,087	117%
United Community Plan [1202]	$1,087	117%
UnitedHealthcare	$1,087	117%
Veterans Admin [9003]	$1,087	117%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$1,087	117%
Cca [1215]	$1,141	123%
Zzzcca Onecare [1216]	$1,141	123%
Eternalhealth [1227]	$1,152	124%
Fallon [8008]	$1,413	152%
Meritain Health [1023]	$1,445	156%
Mass General Brigham Health Plan Commercial [8009]	$1,496	161%
Mass General Brigham Health Plan Prime [7003]	$1,496	161%
Cigna	$1,930	208%
Tufts [8002]	$1,930	208%

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 $889.
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 Boston Medical Center-Brighton 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.