Upper GI endoscopy with biopsy at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital. CPT 43239.
What IHC Health Services Inc., DBA Intermountain Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$133–$899range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| American Health | Medicare Adv UT HMO I-SNP | $361 |
| Health Plan of Nevada | Medicaid | $361 |
| Healthy U | Medicaid | $361 |
| Molina | Medicaid | $361 |
| Molina | Medicare Advantage | $361 |
| Molina | Medicare Choice Care HMO | $361 |
| Molina | Medicare Complete Care HMO SNP | $361 |
| SelectHealth | Medicaid | $361 |
| Southwest Behavioral Health | Behavioral Health | $361 |
| UHC | Medicare Advantage | $361 |
| TriWest | Veterans Choice | $899 |
| Tricare | Tricare | $899 |
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All common services at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital