Upper GI endoscopy with biopsy at SSM Health St. Agnes Hospital - Fond du Lac. CPT 43239.
What SSM Health St. Agnes Hospital - Fond du Lac publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$673–$4,761range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MOLINA | Medicare Managed Care Plan | $673 |
| BCBS | Anthem Medicare Managed Care Plan | $897 |
| Wellcare | Medicare Managed Care Plan | $915 |
| FABOH | All Commercial Plans | $1,484 |
| DOC | Government | $1,731 |
| BCBS | Blue Preferred / Blue Preferred Plus HMO/POS | $2,654 |
| BCBS | Blue Access PPO | $3,335 |
| BCBS | Blue Traditional Traditional | $3,335 |
| Centivo | Broad(WI1) Other Commercial Plan | $3,579 |
| Centivo | Median(WI2) Other Commercial Plan | $3,579 |
| Centivo | Value(WI3) Other Commercial Plan | $3,579 |
| Network Health Plan | HMO/POS | $4,761 |
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All common services at SSM Health St. Agnes Hospital - Fond du Lac