CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hospital Metropolitano Dr Susoni

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$395

about 0.4× the $927 Medicare rate · typically $121–$815

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $395 Cash price $130 Hospital's list price $130

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

1 of 6 major insurers have a published price at this hospital

✓ Humana UnitedHealthcareBlue Cross Blue ShieldAetnaCignaKaiser Permanente

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
Humanamajor	$125 - $145	13%
+ 6 smaller / regional plans	$88 - $166

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 130), 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 Hospital Metropolitano Dr Susoni 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 (%)

Enter your details and press estimate to compare.

Other Procedures at Hospital Metropolitano Dr Susoni

Compare: Upper endoscopy with biopsy at other PR hospitals

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