CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Artesia General Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $411
Cash Discount Price: $265
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Artesia General Hospital is $411. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.44x the Medicare baseline. Located in 702 N 13Th Street, Artesia, NM.

Cash / Self-Pay

$265

Average discount available for prompt cash payment at this facility.

Insurance Median

$411

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: $265 (29%)

Insurance Median: $411 (44%)

Cash: $265 (29% of Medicare)

Ins. Median: $411 (44% 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.

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
Zelis	$121 - $1,090	13%
First Health	$171 - $1,169	18%
Blue Cross Blue Shield	$265 - $908	29%
Geha	$309 - $908	33%
Omni Networks	$309	33%
Three Rivers Provider Network	$332	36%
Cigna	$376 - $398	41%
Galaxy Health	$398	43%
One Health Plan	$398	43%
Multiplan	$402	43%
United Payors & United Providers	$411	44%
Providence Risk & Insurance Services	$420 - $1,817	45%
Molina Healthcare Of New Mexico	$715 - $1,526	77%
Presbyterian Health Plan	$715 - $908	77%
UnitedHealthcare	$715 - $908	77%
Triwest	$890	96%
Humana	$908 - $999	98%
Vistacare Hospice	$908	98%
New Mexico Health Connections	$1,544	167%

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 $265.
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 Artesia General 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.