Upper endoscopy with biopsy
Facility: Brigham and Women's Hospital
Billing Code: 43239 (CPT)
This hospital's typical commercial price is $871 compared to the $1,182 fair price benchmark.
5-Star CMS clinical quality rating paired with 0.74× fair market pricing.
A typical price — 0 charge more and 5 charge less, among the 9 MA hospitals compared.
Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.
Note: 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 $1,182 (about 1.3× the $927 Medicare rate). Brigham and Women's Hospital charges insurers about $871, or about $2,769 in cash — below the fair price — a good deal. Located in Boston, MA.
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
5 of 6 major insurers have a published price at this hospital
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 | $762 - $3,017 | 82% |
| Blue Cross Blue Shieldmajor | $871 - $1,929 | 94% |
| Aetnamajor | $1,147 - $2,968 | 124% |
| Cignamajor | $1,968 - $2,935 | 212% |
| Humanamajor | $1,113 | 120% |
| Harvard Pilgrim | $762 | 82% |
| Molina | $1,091 | 118% |
| Tufts Health Plan | $1,091 | 118% |
| + 6 smaller / regional plans | $1,113 - $2,968 |
Self-Pay How to get the cash price
Insurance Before you use insurance
Estimate your out-of-pocket cost
A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.
Other Procedures at Brigham and Women's Hospital
Compare: Upper endoscopy with biopsy at other MA hospitals
- Holyoke Medical Center · Holyoke $94
- Metrowest Medical Center · Framingham $380
- St Vincent Hospital · Worcester $380
- North Adams Regional Hospital Corporation · North Adams $763
- Fairview Hospital · Great Barrington $803
- Cambridge Health Alliance · Cambridge $871
- Newton-Wellesley Hospital · Newton $871
- Nantucket Cottage Hospital · Nantucket $871
Insurance negotiated median for the same procedure, sorted lowest first.
Audit a Bill or Quote at Brigham and Women's Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $1,340
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $1,340).
Self-Pay Cash Rate ($2,769) Beats Your Bill
Brigham and Women's Hospital's published 45 CFR § 180 self-pay cash rate is $2,769 (vs. $871 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $1,182 Fair BaseRate ($927 Medicare)
Your bill ($3,692) is $2,510 above the denoised Fair BaseRate ($1,182) and 4.0× the $927 Medicare rate.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.