How Much Does Upper Endoscopy (EGD) with Biopsy Cost?
Also known as: Egd biopsy single/multiple (CPT 43239)
A procedure where a camera on a flexible tube is inserted through the mouth to examine the esophagus, stomach, and small intestine, with tissue samples taken.
Upper Endoscopy (EGD) with Biopsy (CPT 43239) costs $124 at Medicare rates. Hospital outpatient rate: $927.
Cost Comparison by Payer
How much Egd biopsy single/multiple costs across different settings and payers
Patient Guide: Upper Endoscopy (EGD) with Biopsy
What you need to know before your appointment
What to Expect
You are sedated. A thin, flexible scope is passed through your mouth and into your stomach. The doctor examines the lining and may take small tissue samples.
How Long Does It Take?
15-30 minutes procedure, 30-60 minutes recovery
Common Reasons Doctors Order This
Persistent heartburn, difficulty swallowing, stomach pain, anemia, suspected ulcer, celiac disease screening
How to Prepare
Fast for 8 hours before. Arrange a ride home. Stop blood thinners as directed.
Procedures Commonly Done Together
These procedures are frequently performed alongside Egd biopsy single/multiple
What Insurance Companies Actually Pay
Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $2,547 | $567 - $6,158 | 9 |
| United | $2,262 | $359 - $5,268 | 10 |
| Cigna | $2,577 | $880 - $7,221 | 9 |
| Humana | $2,194 | $419 - $4,690 | 8 |
| BCBS | $1,429 | $352 - $2,146 | 5 |
| Superior Health Plan | $977 | $948 - $1,409 | 4 |
| KAISER FOUNDATION HEALTH PLAN, INC. | $1,957 | $1,133 - $3,547 | 5 |
| BCBS-TX | $1,090 | $589 - $1,509 | 2 |
| Multiplan | $3,209 | $1,454 - $11,500 | 6 |
| Wellpoint | $674 | $335 - $1,409 | 2 |
| Molina Healthcare | $368 | $368 | 2 |
| Community Health Choice MCD | $375 | $375 | 2 |
How to Reduce Your Cost for Egd biopsy single/multiple
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($419) differs from the facility rate ($124). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $498, compared to $927 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (12.54) x CF ($33.40) = $419
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Egd biopsy single/multiple cost?
The Medicare facility rate for Egd biopsy single/multiple is $124. In a hospital outpatient setting, the rate is $927. At an ambulatory surgery center, the rate is $498. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Egd biopsy single/multiple cost without insurance?
Without insurance, the cost of Egd biopsy single/multiple can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Egd biopsy single/multiple?
Most commercial health insurance plans and Medicare cover Egd biopsy single/multiple when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.