CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Doctors Center Hospital Carolina LLC

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$186

about 0.2× the $927 Medicare rate · typically $109–$660

modeled estimate · not a bill or quote

What this hospital charges insurers

$124

Below the fair price — a good deal

about $62 under the fair price · 0.1× Medicare

Medicare pays $927 Fair price $186 This hospital $124 Cash price $150 Hospital's list price $150

How we calculate the fair BaseRate →

How this hospital compares to other PR hospitals

One of the lower prices — 1 of 4 other PR hospitals charge more for the same procedure.

Cheapest $118 Priciest $175

Black dot = this hospital, among the 5 PR hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $186 (about 0.2× the $927 Medicare rate). Doctors Center Hospital Carolina LLC charges insurers about $124, or about $150 in cash — below the fair price — a good deal. Located in Carolina, PR.

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	$135	15%
+ 5 smaller / regional plans	$85 - $164

Government programs also on file: Medicare.

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 150), 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 Doctors Center Hospital Carolina LLC 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 Doctors Center Hospital Carolina LLC

Compare: Upper endoscopy with biopsy at other PR hospitals

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