CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Holmes County Hospital and Clinics

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,264
Cash Discount Price: $664
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Holmes County Hospital and Clinics is $1,264. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $664. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.36x the Medicare baseline. Located in 239 Bowling Green Road, Lexington, MS.

Cash / Self-Pay

$664

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,264

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: $664 (72%)

Insurance Median: $1,264 (136%)

Cash: $664 (72% of Medicare)

Ins. Median: $1,264 (136% 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
Advhealth-Lex	$521	56%
Ms-Can-Molina-Lex	$736	79%
Ms-Can-Magnolia-Lex	$743	80%
Ms-Can-Truecare-Lex	$750	81%
Cigna	$963	104%
Tricare	$1,019	110%
Humana	$1,036	112%
Mpcn-Lex	$1,079	116%
Medadv_Uhc-Lex	$1,128	122%
Firstchoice-Lex	$1,162	125%
Ambetter / Centene	$1,245	134%
Medadv_Primewell-Lex	$1,245	134%
Medicare (plans)	$1,245	134%
Primewell-Lex	$1,245	134%
Va_Ccn-Lex	$1,245	134%
Medadv_Uhcdsnp-Lex	$1,282	138%
Wellcare-Lex	$1,282	138%
Ppoplus	$1,295	140%
Devoted_Health-Lex	$1,307	141%
Firsthealth-Lex	$1,328	143%
Multiplan-Lex	$1,328	143%
Aetna	$1,411	152%
Phcs-Lex	$1,494	161%
Molina-Chip-Lex	$1,572	170%
Magnolia-Chip-Lex	$1,608	174%
Truecare-Chip-Lex	$1,608	174%
Blue Cross Blue Shield	$1,660	179%
Molina_Exchange-Lex	$1,660	179%
United-Lex	$1,660	179%
United-Options-Lex	$1,660	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 $664.
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 Holmes County Hospital and Clinics 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.