CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Rehoboth McKinley Christian Health Care Services

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,312
Cash Discount Price: $1,204
vs. Medicare Baseline: 3.57x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Rehoboth McKinley Christian Health Care Services is $3,312. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,204. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.57x the Medicare baseline. Located in 1901 Red Rock Drive, Gallup, NM.

Cash / Self-Pay

$1,204

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,312

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: $1,204 (130%)

Insurance Median: $3,312 (357%)

Cash: $1,204 (130% of Medicare)

Ins. Median: $3,312 (357% 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 357% of the Medicare baseline (a markup of 257%). 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
Medicare (plans)	$963	104%
Triwest	$963	104%
Usa	$1,060	114%
Coventry	$2,408	260%
UnitedHealthcare	$3,011	325%
Health West	$3,211	347%
Three Rivers	$3,211	347%
Blue Cross Blue Shield	$3,412	368%
Integrated Health	$3,412	368%
Humana	$3,613	390%
Multiplan	$3,613	390%
Cigna	$3,733	403%
Presbyterian	$3,733	403%
Associated Plan Administrators	$3,813	411%

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 $1,204.
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 Rehoboth McKinley Christian Health Care Services 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.