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Procedure Pricing Comparison

Upper endoscopy with biopsy Cost

Location: Worcester, MA Metro Area

CPT Code: 43239 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
1.00×vs. Fair Market Price
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Compares typical commercial prices against the fair price benchmark after accounting for local wages and case complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Factual Overview

A Upper endoscopy with biopsy in the Worcester, MA Metro Area area ranges from $380 to $8,154 across 5 facilities — a 21.5× swing for the exact same procedure, so where you go matters. Each facility below links to its own page, where its price is checked against the fair BaseRate. Start with the cheapest and compare.

Hospital Comparison Table (Ordered by Price)

Hospital Details Cash Price Actions
St Vincent Hospital
★ No CMS Rating | |
Unavailable Cost
Milford Regional Medical Center
★ No CMS Rating | |
Unavailable Cost
Heywood Hospital -
★ No CMS Rating | |
$1,499 Cost
UMass Memorial Health - Harrington Hospital
★ No CMS Rating | |
$8,081 Cost
UMass Memorial Healthalliance Hospitals
★ No CMS Rating | |
$8,154 Cost
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at St Vincent Hospital (Zero PHI Required)

CPT 43239
Fair BaseRate™ $380
Medicare Rate $220
Self-Pay Cash $380
Insurer Median $8,154
Pre-filled with St Vincent Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $7,104 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $7,104

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 = $7,104).

Step 2 · Cash vs. Insurance Arbitrage Save $19,190 Paying Cash

Self-Pay Cash Rate ($380) Beats Your Bill

St Vincent Hospital's published 45 CFR § 180 self-pay cash rate is $380 (vs. $8,154 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$19,190 Above Fair BaseRate

Negotiate Toward $380 Fair BaseRate ($220 Medicare)

Your bill ($19,570) is $19,190 above the denoised Fair BaseRate ($380) and 89.0× the $220 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.