CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Fairview Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,517
Cash Discount Price: $2,171
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Fairview Hospital is $1,517. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,171. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.64x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$2,171

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,517

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: $2,171 (234%)

Insurance Median: $1,517 (164%)

Cash: $2,171 (234% of Medicare)

Ins. Median: $1,517 (164% 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
Capital District Physicians' Health Plan	$116 - $2,390	13%
Medicaid / KanCare	$116 - $2,804	13%
Comm Fallon Qhp	$203 - $1,636	22%
Other Government	$373 - $1,036	40%
Workers Comp	$376 - $1,693	41%
Medicare (plans)	$429 - $1,019	46%
Hospice	$436 - $1,036	47%
UnitedHealthcare	$436 - $2,284	47%
Health New England	$442 - $2,804	48%
Fallon	$450 - $1,169	49%
Blue Cross Blue Shield	$493 - $2,257	53%
Commcare Alliance	$515 - $1,015	56%
Comm Hne Hmo	$718 - $1,832	77%
Unicare	$742 - $1,722	80%
Comm Hne Ppo	$763 - $1,946	82%
Point32Health	$1,082 - $2,523	117%
Allways Nhp	$1,239 - $1,718	134%
Aetna	$1,446 - $2,005	156%
Cigna	$1,723 - $2,470	186%
Mvp	$1,723 - $2,390	186%
Oxford	$1,723 - $2,390	186%
First Health	$1,781 - $2,523	192%
Connecticare	$1,819 - $2,523	196%
Consolidated Health Plans	$1,819 - $2,523	196%
Other Commercial	$1,819 - $2,523	196%
Phcs	$1,819 - $2,523	196%
Self Pay	$1,819 - $2,523	196%
Bmchnp	$2,916	315%

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 $2,171.
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 Fairview 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.