CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Boston Children's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,187
Cash Discount Price: $2,916
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Boston Children's Hospital is $2,187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,916. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.36x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$2,916

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,187

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: $2,916 (315%)

Insurance Median: $2,187 (236%)

Cash: $2,916 (315% of Medicare)

Ins. Median: $2,187 (236% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 236% of the Medicare baseline (a markup of 136%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Cdphp	$1,429 - $2,479	154%
Harvard Pilgrim	$1,482 - $1,970	160%
Blue Cross Blue Shield	$1,645 - $1,925	178%
United	$1,744 - $2,436	188%
Aetna	$1,750 - $2,444	189%
Mgb/Allways	$1,773 - $2,156	191%
Tufts Public Plan	$1,791 - $1,795	193%
United Ri Nj Ny	$1,837	198%
Ambetter / Centene	$1,843	199%
Carelon Strategies/Bhs	$1,895	205%
UnitedHealthcare	$1,895 - $2,479	205%
Carelon/Beacon	$2,187	236%
Fallon	$2,225 - $2,248	240%
Health New England	$2,356	254%
Cigna	$2,479 - $2,631	268%
Ets/Lifetrac	$2,479	268%
Interlink Transplant	$2,479	268%
Community Health Options	$2,624	283%
Humana	$2,624	283%
Coventry/Hcvm/First Health	$2,683	290%
Multiplan/Phcs	$2,683 - $2,770	290%

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 $2,916.
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 Children'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.