Upper GI endoscopy with biopsy at Ascension Seton Smithville (Ascension Seton). CPT 43239.
What Ascension Seton Smithville (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–$1,590range 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 | 4174_blue Cross Chip (Smv) Outpatient 202412 | $335 |
| BCBS Chip/Chip Perinate | 4174_blue Cross Chip/Star Kids (Smv) Outpati | $335 |
| BCBS Star | 4219_chirp Blue Cross Star (Chi,Dcn) Outpatient 20241201 | $335 |
| BCBS Star | 4225_chirp Blue Cross Star (Smv) Outpatient 20241201 | $335 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $335 |
| BCBS Star Kids | 5015_blue Cross Star Kids (Smv) Outpatient 20241201 | $335 |
| Dell Chip/Chip Perinate | 4179_dell Chip/Star Kids (Chi,Dcn) Outpatien | $335 |
| Dell Chip/Chip Perinate | 4185_dell Chip/Star Kids (Smv) Outpatient 20 | $335 |
| Dell Star | 4230_chirp Dell Star (Chi,Dcn) Outpatient 20241201 | $335 |
| Dell Star | 4236_chirp Dell Star (Smv) Outpatient 20241201 | $335 |
| UHC Star | 4253_chirp UHC Star (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star | 4259_chirp UHC Star (Smv) Outpatient 20241201 | $335 |
| UHC Star Kids | 4311_uhc Star Kids (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star Kids | 4317_uhc Star Kids (Smv) Outpatient 20241201 | $335 |
| UHC Star Plus | 4264_chirp UHC Star Plus (Chi,Dcn) Outpatient 20241201 | $335 |
| UHC Star Plus | 4270_chirp UHC Star Plus (Smv) 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 | 4163_amerigroup Chip/Star Kids (Smv) Ou | $335 |
| Wellpoint Chip/Chip Perinate | 4163_wellpoint/Amerigroup Chip (Smv) 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 | 4203_chirp Amerigroup Star (Smv) Outpatient 20241201 | $335 |
| Wellpoint Star | 4203_chirp Wellpoint/Amerigroup Star (Smv) Outpatient | $335 |
| Wellpoint Star Kids | 4970_wellpoint/Amerigroup Star Kids (Chi,Dcn) Ou | $335 |
| Wellpoint Star Kids | 4982_wellpoint/Amerigroup Star Kids (Smv) Outpat | $335 |
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All common services at Ascension Seton Smithville (Ascension Seton)