CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lovelace Regional Hospital - Roswell

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $4,245
Cash Discount Price: $1,959
vs. Medicare Baseline: 4.58x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Lovelace Regional Hospital - Roswell is $4,245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,959. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 4.58x the Medicare baseline. Located in 117 East 19Th Street, Roswell, NM.

Cash / Self-Pay

$1,959

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,245

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: $1,959 (211%)

Insurance Median: $4,245 (458%)

Cash: $1,959 (211% of Medicare)

Ins. Median: $4,245 (458% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 458% of the Medicare baseline (a markup of 358%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
The Health Plan [2915]	$1,319	142%
Benefit Management [1175]	$3,266	352%
Medicare (plans)	$3,266	352%
Zelis [2385]	$3,266	352%
Caprock Health Plans [1200]	$4,245	458%
Magellan Behavioral Commercial [2895]	$4,245	458%
Presbyterian Health Plan [1830]	$4,245	458%
Cigna	$4,484	484%
Samba Health [2305]	$4,484	484%

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 $1,959.
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 Lovelace Regional Hospital - Roswell 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.