Upper GI endoscopy with biopsy at Intermountain Health Primary Children's Hospital. CPT 43239.
What Intermountain Health 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 Intermountain Health Primary Children's Hospital