CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: San Juan Regional Medical Center Inc

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,253

about 1.4× the $927 Medicare rate · typically $960–$1,253

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $1,253 Cash price $2,188

How we calculate the fair BaseRate →

Insurer prices not shown for this procedure

This hospital’s published rates for this billing code don’t look like a per-visit price — they appear to be a full-stay total filed under an hourly code — so we’re not showing a per-insurer breakdown we can’t stand behind. The fair price above is your best reference; call the hospital’s billing office to confirm the actual charge.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,188), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm San Juan Regional Medical Center Inc is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at San Juan Regional Medical Center Inc

Compare: Upper endoscopy with biopsy at other NM hospitals

Insurance negotiated median for the same procedure, sorted lowest first.