Upper GI endoscopy with biopsy at Ascension St. Vincent's Southside (St. Luke's-St. Vincent's HealthCare, Inc.). CPT 43239.
What Ascension St. Vincent's Southside (St. Luke's-St. Vincent's HealthCare, Inc.) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$903–$11,236range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana PPO Mcr Replacement | 1406_medicare Advantage Humana PPO Outpat | $922 |
| Bc Advantage Mcr Replacement | 1399_medicare Advantage Blue Cross Outp | $941 |
| Blue Cross Alignment | 1398_medicare Advantage Alignment Healthcare Ou | $941 |
| Community Hospice | 1402_medicare Advantage Community Hospice Outpatie | $941 |
| Coventry Mcr Replacement HMO | 1403_medicare Advantage Coventry HMO Ou | $941 |
| Haven Hospice | 1404_medicare Advantage Haven Hospice Outpatient 20250 | $941 |
| Medicare Other (No Seq) | 1388_medicare (No Seq) Outpatient 20250101 | $941 |
| Medicare Replacement | 1408_medicare Advantage Outpatient 20250101 | $941 |
| Pace Place | 1480_pace Program Outpatient 20190301 | $941 |
| Research Study Encore Borland-Groover | 1451_research Study Encore-Bor | $941 |
| Veterans Administration | 1395_veterans Administration Outpatient 2025 | $941 |
| Wellcare | 1445_ Medicare Advantage Wellcare Outpatient 20250101 | $941 |
| Cigna Healthspring | 1396_cigna Healthspring Outpatient 20250101 | $951 |
| Humana HMO Mcr Replacement | 1405_medicare Advantage Humana HMO Outpat | $951 |
| UHC Wellmed Mcr Replacement | 1478_medicare Advantage United Health CA | $951 |
| Careplus Mcr Replacement | 1401_medicare Advantage Careplus Outpatient | $960 |
| Gold Kidney Medicare Advantage | 1433_gold Kidney Medicare Advantage O | $960 |
| Aetna Mcr Replacement | 1397_medicare Advantage Aetna Outpatient 20250 | $969 |
| Smarthealth | 1411_smarthealth Outpatient 20250101 | $1,318 |
| Bright Health | 1400_medicare Advantage Bright Health Outpatient 20250 | $1,365 |
| Aetna Qualified Health Plans | 1385_aetna Qualified Health Plans (Qhp) | $1,459 |
| Aetna Whole Health | 1386_aetna Whole Health Outpatient 20250101 | $1,459 |
| Oscar Health Plan | 1420_oscar Health Plan Outpatient 20250401 | $1,506 |
| Employer Direct Healthcare | 1498_employer Direct Healthcare Outpatien | $1,647 |
| 90 Degree Benefits | 1387_90 Degree Benefits Outpatient 20250101 | $1,694 |
| Avmed Exchange | 1482_avmed Exchange Outpatient 20250201 | $1,694 |
| Molina Exchange | 1393_molina Exchange Outpatient 20250101 | $1,741 |
| Occunet | 1392_medicare Advantage Occunet Outpatient 20250101 | $1,741 |
| Ambetter Commercial-Exchange | 1394_sunshine Ambetter Exchange Commerc | $1,788 |
| Aetna New Business | 904_aetna New Business Discount Outpatient 202110 | $1,929 |
Inpatient
—cash price (self-pay)
—list price
$903–$11,236range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana HMO Cardiology Mcr Replacement | 1535_medicare Advantage Humana | $903 |
| Bc Advantage Mcr Replacement | 1530_medicare Advantage Blue Cross Inpa | $941 |
| Blue Cross Alignment | 1529_medicare Advantage Alignment Healthcare In | $941 |
| Coventry Mcr Replacement HMO | 1533_medicare Advantage Coventry HMO In | $941 |
| Humana PPO Mcr Replacement | 1538_medicare Advantage Humana PPO Inpati | $941 |
| Medicare Other (No Seq) | 1527_medicare (No Seq) Inpatient 20251001 | $941 |
| Medicare Replacement | 1539_medicare Advantage Inpatient 20251001 | $941 |
| Pace Place | 1547_pace Program Inpatient 2051001 | $941 |
| Research Study Encore Borland-Groover | 1548_research Study Encore-Bor | $941 |
| Veterans Administration | 1552_veterans Administration Inpatient 20251 | $941 |
| Wellcare | 1542_medicare Advantage Wellcare Inpatient 20251001 | $941 |
| Humana HMO Mcr Replacement | 1537_medicare Advantage Humana HMO Inpati | $951 |
| UHC Wellmed Mcr Replacement | 1541_medicare Advantage United Health CA | $951 |
| Careplus Mcr Replacement | 1532_medicare Advantage Careplus Inpatient | $960 |
| Cigna Healthspring | 1523_cigna Healthspring Inpatient 20251001 | $960 |
| Gold Kidney Medicare Advantage | 1526_gold Kidney Medicare Advantage I | $960 |
| Aetna Mcr Replacement | 1528_medicare Advantage Aetna Inpatient 202510 | $969 |
| Bright Health | 1531_medicare Advantage Bright Health Inpatient 202510 | $1,270 |
| Smarthealth | 1549_smarthealth Inpatient 20251001 | $1,318 |
| Aetna Qualified Health Plans | 1520_aetna Qualified Health Plans (Qhp) | $1,459 |
| Aetna Whole Health | 1521_aetna Whole Health Inpatient 20251001 | $1,459 |
| Oscar Health Plan | 1545_oscar Health Plan Inpatient 20251001 | $1,506 |
| Employer Direct Healthcare | 1497_employer Direct Healthcare Inpatient | $1,647 |
| 90 Degree Benefits | 1518_90 Degree Benefits Inpatient 20251001 | $1,694 |
| Avmed Exchange | 1522_avmed Exchange Inpatient 20251001 | $1,694 |
| Molina Exchange | 1544_molina Exchange Inpatient 20251001 | $1,741 |
| Ambetter Commercial-Exchange | 1550_sunshine Ambetter Exchange Commerc | $1,788 |
| Aetna New Business | 1519_aetna New Business Discount Inpatient 202510 | $1,929 |
| Occunet | 1540_medicare Advantage Occunet Inpatient 20251001 | $2,117 |
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All common services at Ascension St. Vincent's Southside (St. Luke's-St. Vincent's HealthCare, Inc.)