Upper GI endoscopy with biopsy at Ascension Seton Edgar B. Davis (Ascension Seton). CPT 43239.
What Ascension Seton Edgar B. Davis (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$141–$1,000range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | 1135_champva Rest_tx 20180301 | $141 |
| Champva | 1136_champva Austin 20180301 | $144 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $335 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $335 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip (Ebd) Outpatient 202412 | $335 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip/Star Kids (Ebd) Outpati | $335 |
| BCBS Star | 4219_chirp Blue Cross Star (Chi,Dcn) Outpatient 20241201 | $335 |
| BCBS Star | 4221_chirp Blue Cross Star (Ebd) Outpatient 20241201 | $335 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $335 |
| BCBS Star Kids | 5007_blue Cross Star Kids (Ebd) Outpatient 20241201 | $335 |
| Dell Chip/Chip Perinate | 4179_dell Chip/Star Kids (Chi,Dcn) Outpatien | $335 |
| Dell Chip/Chip Perinate | 4181_dell Chip/Star Kids (Ebd) Outpatient 20 | $335 |
| Dell Star | 4230_chirp Dell Star (Chi,Dcn) Outpatient 20241201 | $335 |
| Dell Star | 4232_chirp Dell Star (Ebd) Outpatient 20241201 | $335 |
| UHC Star | 4253_chirp UHC Star (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star | 4255_chirp UHC Star (Ebd) Outpatient 20241201 | $335 |
| UHC Star Kids | 4311_uhc Star Kids (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star Kids | 4313_uhc Star Kids (Ebd) Outpatient 20241201 | $335 |
| UHC Star Plus | 4264_chirp UHC Star Plus (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star Plus | 4266_chirp UHC Star Plus (Ebd) Outpatient 20241201 | $335 |
| Wellpoint Chip/Chip Perinate | 4157_amerigroup Chip/Star Kids (Chi,Dcn | $335 |
| Wellpoint Chip/Chip Perinate | 4157_wellpoint/Amerigroup Chip (Chi,Dcn | $335 |
| Wellpoint Chip/Chip Perinate | 4159_amerigroup Chip/Star Kids (Ebd) Ou | $335 |
| Wellpoint Chip/Chip Perinate | 4159_wellpoint/Amerigroup Chip (Ebd) Ou | $335 |
| Wellpoint Star | 4197_chirp Amerigroup Star (Chi,Dcn) Outpatient 20241 | $335 |
| Wellpoint Star | 4197_chirp Wellpoint/Amerigroup Star (Chi,Dcn) Outpat | $335 |
| Wellpoint Star | 4199_chirp Amerigroup Star (Ebd) Outpatient 20241201 | $335 |
| Wellpoint Star | 4199_chirp Wellpoint/Amerigroup Star (Ebd) Outpatient | $335 |
| Wellpoint Star Kids | 4970_wellpoint/Amerigroup Star Kids (Chi,Dcn) Ou | $335 |
| Wellpoint Star Kids | 4974_wellpoint/Amerigroup Star Kids (Ebd) Outpat | $335 |
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All common services at Ascension Seton Edgar B. Davis (Ascension Seton)