CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ochsner St Mary

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $853
Cash Discount Price: $1,020
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ochsner St Mary is $853. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,020. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.92x the Medicare baseline. Located in 1125 Marguerite Street, Morgan City, LA.

Cash / Self-Pay

$1,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$853

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: $1,020 (110%)

Insurance Median: $853 (92%)

Cash: $1,020 (110% of Medicare)

Ins. Median: $853 (92% 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
Tricare	$361 - $914	39%
Healthy Blue (Healthy Louisiana)	$481	52%
Humana	$481 - $853	52%
Louisiana Healthcare Connections (Healthy Louisiana)	$481	52%
UnitedHealthcare	$481 - $2,616	52%
Aetna	$496 - $4,349	54%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$496	54%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$853	92%
Blue Cross Blue Shield	$853 - $1,055	92%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$853	92%
Medicare (plans)	$853	92%
Ochsner Health Plan	$853	92%
Zelis	$1,284	139%
Claritev D/B/A Multiplan/Phcs/American Life Care	$1,516	164%
Verity Commercial And First Choice Network	$2,754	297%
Cigna	$2,968	320%
First Health Network	$3,417	369%
Healthcomp & Personify Health (Formerly Gilsbar)	$3,570	385%

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 $1,020.
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 St Mary 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.