CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ochsner Watkins Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,335
Cash Discount Price: $1,527
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Ochsner Watkins Hospital is $1,335. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,527. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.44x the Medicare baseline. Located in 605 South Archusa Avenue, Quitman, MS.

Cash / Self-Pay

$1,527

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,335

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: $1,527 (165%)

Insurance Median: $1,335 (144%)

Cash: $1,527 (165% of Medicare)

Ins. Median: $1,335 (144% 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%
Prime Health Services Ppo -Workers Comp	$1,027	111%
Cor Vel	$1,049	113%
Humana	$1,067 - $1,322	115%
UnitedHealthcare	$1,182 - $1,322	128%
Cigna	$1,269 - $1,322	137%
Medicare (plans)	$1,322 - $1,520	143%
Ambetter / Centene	$1,335	144%
Magnolia Health Plan – Wellcare By All Well Of Mississippi	$1,335	144%
Shared Health Mississippi	$1,388	150%
Aetna	$1,481	160%
Select Administrative Services Network	$1,595	172%
Claritev D/B/A Multiplan/Phcs/American Life Care	$1,709	184%
Zelis	$1,709	184%
Blue Cross Blue Shield	$1,823	197%
Prime Health Services Ppo	$1,823	197%
Primewell Health Services Commercial Exchange Plan	$1,868	202%
Primewell Health Services – Commercial	$1,868	202%

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 $1,527.
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 Watkins 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.