Upper GI endoscopy with biopsy at Intermountain Health Good Samaritan Medical Center. CPT 43239.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$933–$6,503range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp | Aarp | $933 |
| United Healthcare Mrp | UHC Mrp Php Prime | $933 |
| United Healthcare Mrp | UHC Rmhp Mrp Dualcare | $933 |
| United Healthcare Mrp | United Healthcare Mrp | $933 |
| United Healthcare Mrp | United Healthcare Optum Mrp | $933 |
| Kaiser Snp | Kaiser Snp | $942 |
| Select Health | Select Health | $942 |
| Denv Hlth Med Plan | Denver Hlth Med Pl | $2,450 |
| Denv Hlth Med Plan | Denver Hlth Med Plan Exchange | $2,450 |
| Cigna | Cigna Co Public Option | $2,642 |
| Choicecare Humana | Choicecare Humana HMO EPO | $2,993 |
| Choicecare Humana | Choicecare Humana PPO | $2,993 |
| Cigna | Cigna Connect Exchange | $3,211 |
| Cigna | Cigna Surefit | $3,211 |
| Cigna | Cigna HMO | $4,283 |
| Cigna | Cigna Indemnity | $4,283 |
| Cigna | Cigna Local Plus | $4,283 |
| Cigna | Cigna Other | $4,283 |
| Cigna | Cigna POS/Qpos | $4,283 |
| Cigna | Cigna PPO | $4,283 |
| Cigna | Eighth Dist Elect Ben Pln | $4,283 |
| Cigna | Health-Partners | $4,283 |
| Geha | Geha | $4,533 |
| Geha | Geha Mcr Supplemental | $4,533 |
| BCBS/Anthem | BCBS Co Federal | $4,667 |
| BCBS/Anthem | BCBS Co HMO | $4,667 |
| BCBS/Anthem | BCBS Co PPO | $4,667 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $5,838 |
| Kaiser Perm HMO | Kaiser Out Of State | $5,838 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $5,838 |
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All common services at Intermountain Health Good Samaritan Medical Center