Upper GI endoscopy with biopsy at Mount St. Mary's Hospital. CPT 43239.
What Mount St. Mary's Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$730cash price (self-pay)
$730list price
$41.68–$3,295range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hospice [550001] | Niagara [55000102] | $89.75 |
| Hospice [550001] | Erie [55000101] | $89.75 |
| No Fault [114001] | Erie Insurance Nf [1140113] | $302 |
| NO FAULT [114001] | Farmers Insurance [11500104] | $302 |
| No Fault [114001] | Geico Ins [11400103] | $302 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Chp Medicaid [35110202] | $600 |
| Amerigroup [350102] | BCBS Amerigroup Mcd [35010203] | $600 |
| Amerigroup [350102] | Chp BCBS Amg Non Mcd [35010202] | $600 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Chp Non-Medicaid [351102 | $600 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Medicaid [35110201] | $600 |
| Amerigroup [350102] | Chp BCBS Amg Mcd [35010201] | $600 |
| Upmc Health Plan [100181] | Upmc Health Plan [10018101] | $663 |
| Commercial - Other [100172] | Commercial Other [10017215] | $682 |
| Commercial - Other [100172] | Healthy Living Partnershi [10017212] | $682 |
| Commercial - Other [100172] | Guardian [10017203] | $682 |
| Commercial - Other [100172] | Pomco [10017213] | $682 |
| Commercial - Other [100172] | Royal Sunalliance [10017209] | $682 |
| Humana [100052] | Humana PPO [10005202] | $682 |
| Boilermakers Natl. Health [100159] | Boilermakers Natl. Health [100159 | $682 |
| Commercial - Other [100172] | Board Of Pensions [10017201] | $682 |
| Commercial - Other [100172] | Mutual Of Omaha [10017211] | $682 |
| Commercial - Other [100172] | Optum Behavioral Health [10017210] | $682 |
| National Association Of Letter Carriers [100067] | Nalc Health Benefit | $682 |
| Commercial - Other [100172] | Metrahealth [10017208] | $682 |
| Commercial - Other [100172] | Healthsource [10017204] | $682 |
| Commercial - Other [100172] | Sunshine State Health Pln [10017207] | $682 |
| Commercial - Other [100172] | Wausau Insurance [10017205] | $682 |
| Commercial - Other [100172] | Gerber Life Ins [10017202] | $682 |
| Humana [100052] | Humana One [10005203] | $682 |
| Baker/Confectionary Union [100158] | Baker/Confectionary Union [100158 | $682 |
Inpatient
$730cash price (self-pay)
$730list price
$41.68–$3,295range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Essential [100152] | Bc Essential Plan 3 And 4 [10015202] | $104 |
| Beacon Essential [350122] | Beacon Essential Plan 3 And 4 [35012202] | $108 |
| Beacon Health Medicare [450127] | Beacon Health Medicare [45012701] | $132 |
| United Healthcare Essential [100253] | UHC Essential Plan 200-250 [100 | $140 |
| United Healthcare Medicaid [350101] | UHC Medicaid [35010101] | $140 |
| Beacon Essential [350122] | Beacon Essential Plan 1 And 2 [35012201] | $144 |
| Molina Medicaid [350107] | Affinity Molina Plus (Harp) [35010703] | $148 |
| BCBS Medicare [450116] | Federal Bc Over 65 [45011602] | $170 |
| Amerigroup [350102] | Chp BCBS Amg Non Mcd [35010202] | $177 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Chp Medicaid [35110202] | $177 |
| Medicaid In State [300001] | Medicaid Episodic [30000103] | $177 |
| Medicaid Out Of State [309999] | Medicaid Massachusetts [30999906] | $177 |
| Independent Health Medicaid [350106] | Child Health Plus Iha Medicaid | $177 |
| Medicaid In State [300001] | Nys Medical Assistance [30000102] | $177 |
| Medicaid Out Of State [309999] | Medicaid Maine [30999907] | $177 |
| Medicaid Out Of State [309999] | Medicaid Out Of State [30999901] | $177 |
| Humana Medicare [450130] | Humana Medicare Pffs [45013002] | $179 |
| United Healthcare Medicare [450021] | UHC Care Improvement Plus [45002 | $183 |
| Medicare Covid Vac Alt [40000101] | Medicare Covid Vac Alt [4000010102 | $201 |
| Champ Va [700002] | Champ Va [70000201] | $201 |
| Kalos Medicare [450126] | Kalos Medicare Advantage [45012601] | $201 |
| Seneca Nation [450119] | Seneca Nation [45011901] | $201 |
| Blue Cross/Blue Shield [100151] | Empire B/C PPO-Yls [10015108] | $202 |
| United Healthcare Surest [101154] | United Healthcare Surest [10115401 | $202 |
| United Healthcare Umr [100185] | United Healthcare Umr [10018501] | $202 |
| Independent Health [100165] | Choice Plus [10016505] | $209 |
| Fidelis Dual Advantage [450120] | Fidelis Dual Advantage [45012001] | $211 |
| Wellcare Fidelis Dual [450451] | Wellcare Fidelis Dual Access [4504510 | $211 |
| Wellcare [450129] | Wellcare HMO [45012901] | $221 |
| Fidelis Essential [100163] | Fidelis Essential Plan 1 And 2 [10016301] | $241 |
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