CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Dr Dan C Trigg Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,037
Cash Discount Price: $3,216
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Dr Dan C Trigg Memorial Hospital is $1,037. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,216. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.12x the Medicare baseline. Located in 301 East Miel De Luna Avenue, Tucumcari, NM.

Cash / Self-Pay

$3,216

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,037

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: $3,216 (347%)

Insurance Median: $1,037 (112%)

Cash: $3,216 (347% of Medicare)

Ins. Median: $1,037 (112% 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
Presbyterian Health Plan	$947 - $3,710	102%
UnitedHealthcare	$976	105%
Blue Cross Blue Shield	$985	106%
Aetna	$995	107%
Molina Healthcare	$1,014	109%
Humana	$1,033	111%
Western Sky Community Care	$1,042	112%
Wellpoint	$1,658	179%

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 $3,216.
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 Dr Dan C Trigg Memorial 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.