CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ochsner Choctaw General

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,182
Cash Discount Price: $1,732
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ochsner Choctaw General is $1,182. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,732. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.28x the Medicare baseline. Located in 401 Vanity Fair Lane, Po Box 618, Butler, AL.

Cash / Self-Pay

$1,732

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,182

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: $1,732 (187%)

Insurance Median: $1,182 (128%)

Cash: $1,732 (187% of Medicare)

Ins. Median: $1,182 (128% 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
Medicaid / KanCare	$672 - $705	73%
Humana	$898 - $1,025	97%
Cigna	$1,025 - $1,253	111%
Magnolia Health Plan – Wellcare By All Well Of Mississippi	$1,025	111%
Medicare (plans)	$1,025 - $1,179	111%
Ambetter / Centene	$1,036	112%
Shared Health Mississippi	$1,077	116%
UnitedHealthcare	$1,182 - $1,253	128%
Aetna	$1,481	160%
Primewell Health Services Commercial Exchange Plan	$1,527	165%
Primewell Health Services – Commercial	$1,527	165%
Select Administrative Services Network	$1,595	172%
Claritev D/B/A Multiplan/Phcs/American Life Care	$1,709	184%
Zelis	$1,709	184%
Prime Health Services Ppo -Workers Comp	$1,818	196%
Prime Health Services Ppo	$1,823	197%
Cor Vel	$1,857	200%
Blue Cross Blue Shield	$2,945	318%

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 $1,732.
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 Ochsner Choctaw General 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.