Upper GI endoscopy with biopsy at Ascension Saint Thomas Rutherford. CPT 43239.
What Ascension Saint Thomas Rutherford publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,093cash price (self-pay)
$3,644list price
$808–$3,638range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Point Comfort Underwriters | 2946_medicare Advantage Point Comfort Und | $808 |
| Americhoice Medicare | 2952_mttn, Sttn Americhoice Medicare Outpatient | $889 |
| Ascension Complete | 2940_ascension Complete Medicare Advantage Outpat | $898 |
| Centurion Of Tn | 2942_medicare Advantage Centurion Of Tn Outpatient 2 | $898 |
| Clover Medicare Advantage | 2943_medicare Advantage Clover Outpatient | $898 |
| Healthspring Mcr Replacement | 2944_medicare Advantage Healthspring Ou | $898 |
| Humana Mcr Replacement | 2945_medicare Advantage Humana Outpatient 202 | $898 |
| Medicare Other | 2947_medicare Other Outpatient 20250101 | $898 |
| Nhc Advantage | 2948_mttn Rhtn Rptn Sdtn Sttn Medicare Advantage Nhc A | $898 |
| Optum Va | 2935_medicare Advantage Optum Va Outpatient 20250101 | $898 |
| Triwest Va Pccc | 1713_triwest Op (West, Rutherford) 20210101 | $898 |
| UHC Mcr Replacement | 2951_mttn Sttn Rptn Medicare Advantage UHC Outpa | $898 |
| Aetna Medadvantage | 2956_rhtn Rptn Sdtn Thtn Mttn Sttn Medicare Advan | $916 |
| Amerigroup Mcr Replacement | 2959_sttn Mttn Medicare Advantage Amerigr | $925 |
| BCBS Bluecare Plus | 2949_mttn Sttn Medicare Advantage Blue Cross Blue | $934 |
| BCBS Mcr Replacement | 2941_medicare Advantage Blue Cross Blue Shield | $943 |
| Windsor Medicare | 2950_mttn Sttn Medicare Advantage Wellcare (Windsor | $943 |
| Ambetter Of Tn | 2933_ambetter Of Tn Outpatient 20250101 | $1,167 |
| Cigna Localplus | 3193_cigna Localplus (Dekalb) 20250601 | $1,185 |
| Cigna Localplus | 3192_rhtn Cigna Localplus 20250601 | $1,197 |
| Cigna PPO | 3199_cigna PPO (Dekalb) 20250601 | $1,239 |
| Cigna HMO | 3196_cigna HMO (Dekalb) 20250601 | $1,247 |
| Oscar Health | 502_oscar Health (Rutherford) Op 20180101 | $1,257 |
| Smart Health | 2936_mttn, Rptn, Rhtn, Sdtn, Thtn Ascension Smart Healt | $1,257 |
| BCBS Missionpoint | 2416_mttn Blue Cross Blue Shield Mission Point 202 | $1,637 |
| Cigna Localplus | 3187_sttn Cigna Localplus 20250601 | $2,984 |
| Cigna Localplus | 3186_mttn Cigna Localplus 20250601 | $3,338 |
| Cigna HMO | 3188_mttn Cigna HMO 20250601 | $3,638 |
Inpatient
—cash price (self-pay)
—list price
$808–$1,257range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Point Comfort Underwriters | 3224_mttn Rhtn Rptn Sdtn Sttn Medicare Ad | $808 |
| Americhoice Medicare | 3207_mttn, Sttn Americhoice Medicare Inpatient | $844 |
| Ascension Complete | 3229_ascension Complete Medicare Advantage Inpati | $898 |
| Centurion Of Tn | 3228_medicare Advantage Centurion Of Tn Inpatient 20 | $898 |
| Clover Medicare Advantage | 3227_medicare Advantage Clover Inpatient 2 | $898 |
| Covid Uninsured Test Fund | 3202_covid Uninsured Test Fund Inpatient 2 | $898 |
| Healthspring Mcr Replacement | 3219_mttn Sttn Rptn Sdtn Rhtn Medicare | $898 |
| Humana Mcr Replacement | 3222_mttn Sttn Medicare Advantage Humana Inpa | $898 |
| Medicare Other | 3204_mttn Sttn Medicare Other Inpatient 20251001 | $898 |
| Nhc Advantage | 3225_mttn Rhtn Rptn Sdtn Sttn Medicare Advantage Nhc A | $898 |
| Optum Va | 3205_medicare Advantage Optum Va Inpatient 20251001 | $898 |
| Triwest Va Pccc | 3235_mttn Sttn Triwest Inpatient 20251001 | $898 |
| UHC Mcr Replacement | 3226_medicare Advantage UHC Inpatient 20251001 | $898 |
| Aetna Medadvantage | 3214_rptn Rhtn Sdtn Thtn Mttn Sttn Medicare Advan | $916 |
| Amerigroup Mcr Replacement | 3210_sttn Mttn Medicare Advantage Amerigr | $925 |
| BCBS Bluecare Plus | 3223_mttn Sttn Medicare Advantage Blue Cross Blue | $934 |
| BCBS Mcr Replacement | 3238_thtn Medicare Advantage Blue Cross Blue Sh | $943 |
| Windsor Medicare | 3220_mttn Sttn Medicare Advantage Wellcare (Windsor | $943 |
| Ambetter Of Tn | 3236_ambetter Of Tn Inpatient 20251001 | $1,167 |
| Smart Health | 3237_mttn, Rptn, Rhtn, Sdtn, Thtn Ascension Smart Healt | $1,257 |
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