Upper GI endoscopy with biopsy at St. Luke's Jerome Standard Charges. CPT 43239.
What St. Luke's Jerome Standard Charges publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$2,526cash price (self-pay)
$2,526list price
$1,013–$2,747range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Mv Va Ccn | $1,013 |
| Medicare Advantage Generic [1019] | Hb Mv Medicare Advantage | $1,013 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Mmcp | $1,013 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Mmcp | $1,013 |
| Blue Cross/Medicare Advantage [1009] | Hb Mv Bci True & Secure Med Adv | $1,023 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Med Adv | $1,033 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Med Adv | $1,033 |
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $1,060 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $1,060 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $1,060 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $1,060 |
| Commercial [1028] | Hb Mv Slhp Select Health | $1,060 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $1,060 |
| Medicare Advantage Aetna [1017] | Hb Mv Aetna Med Adv | $1,114 |
| Commercial [1028] | Hb Mv H2b | $1,895 |
| H2b [1068] | Hb Mv H2b | $1,895 |
| Aetna [1021] | Hb Mv Bp Aetna | $2,021 |
| Cigna [1062] | Hb Mv Cigna | $2,021 |
| Commercial [1028] | Hb Mv Bp Aetna | $2,021 |
| Commercial [1028] | Hb Mv Cigna | $2,021 |
| Providence [1022] | Hb Mv Cigna | $2,021 |
| Webtpa [1071] | Hb Mv Bp Aetna | $2,021 |
| Commercial [1028] | Hb Mv Amps | $2,147 |
| Commercial [1028] | Hb Mv Christian Health Aid | $2,147 |
| Commercial [1028] | Hb Mv First Choice Health | $2,147 |
| First Health [1064] | Hb Mv First Choice Health | $2,147 |
| Webtpa [1071] | Hb Mv First Choice Health | $2,147 |
| Commercial [1028] | Hb Mv Moda Commercial | $2,223 |
| Moda [1055] | Hb Mv Moda Commercial | $2,223 |
| Aetna [1021] | Hb Mv Aetna Trinity Health (St Al'S) | $2,273 |
Inpatient
$2,526cash price (self-pay)
$2,526list price
$1,642–$2,160range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $1,642 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $1,642 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $1,642 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $1,642 |
| Commercial [1028] | Hb Mv Slhp Select Health | $1,642 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $1,642 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $1,642 |
| Mountain Health Co-Op [1067] | Hb Mv Slhp Mountain Health Coop | $1,642 |
| Pacificsource [1020] | Hb Mv Pacificsource Navigator Large Group | $1,642 |
| Pacificsource [1020] | Hb Mv Slhp Pacificsource Navigator Qhp | $1,642 |
| Select Health [1063] | Hb Mv Slhp Select Health | $1,642 |
| Select Health [1063] | Hb Mv Slhp Select Health Qhp | $1,642 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Large Gr | $1,642 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Qhp | $1,642 |
| Pacificsource [1020] | Hb Mv Pacificsource PPO Voyager | $1,895 |
| Commercial [1028] | Hb Mv Multiplan Primary Network | $2,021 |
| Commercial [1028] | Hb Mv Va Ccn | $2,021 |
| Veterans Affairs [1056] | Hb Mv Va Ccn | $2,021 |
| Blue Cross Federal [1008] | Hb Mv Bci PPO Fep | $2,160 |
| Blue Cross Idaho [1007] | Hb Mv Bci PPO Fep | $2,160 |
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