Upper GI endoscopy with biopsy at Samaritan Lebanon Community Hospital. CPT 43239.
What Samaritan Lebanon Community Hospital publishes for this service, straight from its standard-charges file, last updated January 31, 2026.
Outpatient / ER
$185cash price (self-pay)
$925list price
$84.10–$1,190range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Devoted Health | Medicare Advantage - Midlevel - Fac | $130 |
| Healthnet | Medicare Advantage - Midlevel - Fac | $130 |
| Humana | Medicare Advantage - Midlevel - Fac | $130 |
| DEVOTED HEALTH | Medicare Advantage-FAC | $148 |
| Healthnet | Medicare Advantage - Fac | $153 |
| Humana | Medicare Advantage - Fac | $153 |
| MODA | BH - Licensed Psych FAC | $161 |
| Cigna | Facility | $196 |
| Aetna | Fac - Midlevel Lcsw/Lpc/Rdn | $226 |
| Aetna | Fac - Optometrists - Pyschologists- Pt-St-Ot | $256 |
| Aetna | Fac - Midlevel Np-Pa-Cnm | $256 |
| Aetna | Fac - Md-Do | $301 |
| Aetna | Fac - Psychiatric Np | $301 |
| First Choice | Facility | $307 |
| Healthnet | Facility | $313 |
| Devoted Health | Medicare Advantage - Midlevel - Nonfac | $349 |
| Healthnet | Medicare Advantage - Midlevel - Nonfac | $349 |
| Humana | Medicare Advantage - Midlevel - Nonfac | $349 |
| Ihn | Medicaid - Specialty Care | $395 |
| DEVOTED HEALTH | Medicare Advantage-NONFAC | $402 |
| IHN | Medicaid BH Other | $403 |
| Ihn | Medicaid - Primary Care | $403 |
| Healthnet | Medicare Advantage - Nonfac | $411 |
| Humana | Medicare Advantage - Nonfac | $411 |
| MODA | BH - Licensed Psych NONFAC | $443 |
| Providence | Medicare Adv. - Physician | $555 |
| Moda | Bh - Independent Practice - Fac | $555 |
| Moda | Bh - Group Practice - Fac | $555 |
| Moda | Bh - Independent Practice - Nonfac | $555 |
| Cigna | Nonfacility | $580 |
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