Upper GI endoscopy with biopsy at CHI Health Good Samaritan. CPT 43239.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$260–$4,182range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $260 |
| Amerigroup | Medicaid|All Plans | $764 |
| Centene | Medicaid|IA Total Care | $764 |
| IAMolina | Medicaid|All Plans | $779 |
| BCBS - NE | Medicare|All Plans | $888 |
| Humana | Medicare|All Plans | $888 |
| Medica | Medicare|All Plans | $888 |
| PACE | Medicare|All Plans | $888 |
| United | Medicare|All Plans | $888 |
| Centene | Medicare|All Plans | $914 |
| Amerigroup | Medicare|All Plans | $932 |
| Great Plains | Medicare|All Plans | $932 |
| AMPS | Commercial|All Plans | $1,971 |
| Medica | Commercial|CHI Health | $2,461 |
| Medica | Commercial|All Other Plans | $2,892 |
| Greater Omaha Packing | Commercial|Narrow Network | $3,637 |
| Millard Public Schools | Commercial|Narrow Network | $3,637 |
| One World | Commercial|Narrow Network | $3,637 |
| Greater Omaha Packing | Commercial|Broad Network | $4,182 |
| Millard Public Schools | Commercial|Broad Network | $4,182 |
| One World | Commercial|Broad Network | $4,182 |
| Timpte | Commercial|Broad Network | $4,182 |
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