CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Massachusetts General Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,113
Cash Discount Price: $2,769
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Massachusetts General Hospital is $1,113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,769. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.20x the Medicare baseline. Located in 55 Fruit Street, Boston, MA.

Cash / Self-Pay

$2,769

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,113

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: $2,769 (299%)

Insurance Median: $1,113 (120%)

Cash: $2,769 (299% of Medicare)

Ins. Median: $1,113 (120% 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 Alternate [120002]	$762	82%
Harvard Pilgrim [120001]	$762	82%
UnitedHealthcare	$762 - $3,017	82%
Blue Cross Blue Shield	$871 - $1,113	94%
Champva [160001]	$1,058	114%
Tricare	$1,058	114%
Molina [1014]	$1,091	118%
Tufts Health Plan [170001]	$1,091	118%
Commonwealth Care Alliance [1007]	$1,113	120%
Elder Services [1037]	$1,113	120%
Fallon Health [1008]	$1,113	120%
Humana	$1,113	120%
Martin'S Point [160007]	$1,113	120%
Medicare (plans)	$1,113	120%
Mgb Health Plan [150001]	$1,113 - $1,414	120%
Aetna	$1,147 - $2,968	124%
Centers Of Excellence [1026]	$1,392 - $2,651	150%
Cigna	$1,968 - $2,935	212%
International Commercial [140001]	$2,658 - $3,017	287%
Phcs Multiplan [1022]	$2,843	307%

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 $2,769.
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 Massachusetts General 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.