Ambulatory surgery center (ASC)
Standalone outpatient surgery facility; typically the lower-cost setting.
Price risk: Anesthesia and pathology still billed separately.
Find out what healthcare may actually cost before you book
Upper Endoscopy (EGD) Cost in the USA: Cash Price vs Insurance Price
Compare cash and insurance pricing for an upper endoscopy (esophagogastroduodenoscopy / EGD), including the anesthesia, pathology and facility components that frequently inflate the final bill.
Peter Langdon · TreatCompare editor — healthcare price research
Important information for US visitors
This page is general consumer information about US hospital price-transparency data and shoppable-service pricing. It is not insurance advice, billing advice, legal advice, tax advice, or medical advice, and it is not a substitute for an insurance broker, patient advocate, certified medical biller, or attorney. The cash-vs-insurance calculator produces scenario estimates only, based on numbers you enter; an actual bill depends on your plan, network status, prior authorisation, separate professional and facility fees, and the specific procedure code billed. Please verify any quoted price and your estimated patient responsibility directly with your provider and your insurer before booking care.
Could paying cash for an upper endoscopy be lower-cost than using insurance?
Paying cash for an Upper endoscopy can be lower-cost than using insurance when the cash quote is below your likely patient responsibility under insurance. The key comparison is not cash price vs sticker price; it is cash price vs your deductible, coinsurance, copay and out-of-pocket maximum.
See if cash or insurance is lower-cost for your Upper endoscopy
Enter your cash quote and insurance plan numbers — get a scenario estimate in under a minute.
Best first question
Cash or insurance?
Upper endoscopy is rarely an ACA-preventive procedure, so the deductible question almost always applies.
Key billing code
CPT 43235 / 43239
Diagnostic EGD uses CPT 43235; EGD with biopsy uses 43239.
Main hidden issue
Anesthesia bill
Anesthesia is almost always a separate bill that can match or exceed the gastroenterologist fee.
Decision tool
Should I pay cash or use insurance for an Upper endoscopy?
Enter your quote and plan numbers. The result estimates today's payment and flags the deductible trade-off.
Cash route
$2,100
Insurance estimate
$1,340
Current signal
Insurance looks lower-cost by $760
This is a simple estimate. It does not verify network status, prior authorization, separate radiologist bills, contrast, facility fees, or whether a cash payment counts toward your plan deductible or out-of-pocket maximum.
Suggested next step
Insurance looks better on this estimate.
Your result depends on whether more care is likely this plan year and whether the provider is in-network.
Most useful submissions include CPT code, anesthesia fee, pathology fee, provider name, date quoted and whether the amount was cash, allowed amount, EOB patient responsibility or billed charge.
Before booking, ask
Provider
- What CPT code will be billed for this Upper endoscopy?
- Is the cash quote complete, or are professional/facility fees separate?
- Is contrast, anesthesia, pathology or follow-up included if relevant?
- Can you provide the quote in writing before booking?
- Is anesthesia included, and is the anesthesiologist in network?
- Are biopsy and pathology fees included if samples are taken?
- What CPT code will be billed (diagnostic vs biopsy vs interventional)?
- Is anesthesia included in the quoted price and is the anesthesiologist in network?
Insurer
- Is the provider in-network for my exact plan?
- Will this CPT code require prior authorization?
- What patient responsibility do you estimate after deductible, copay and coinsurance?
- If I pay cash, can I submit an out-of-network claim later?
Keep the decision handy
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Data funnel
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Send provider, price, date, what was included and what was excluded.
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Upper endoscopy cost by state
State pages use available CMS/provider records where present, then fall back to the procedure calculator defaults while we collect more quotes and EOBs.
Hospital outpatient department
EGD performed at a hospital outpatient facility.
Price risk: Facility fees often higher than at an ASC.
Endoscopy clinic
GI-specialist clinic offering scope-based procedures.
Price risk: Check anesthesia network status.
What changes an Upper endoscopy bill?
The useful comparison is itemised. These are the fields to pin down before relying on any quote.
| Factor | Why it matters | What to ask |
|---|---|---|
| Anesthesia billing | Anesthesia is a separate bill from the gastroenterologist; out-of-network anesthesiologists are a common surprise-billing trigger. | Ask whether anesthesia is included in the quote and whether the anesthesiologist is in network. |
| Pathology fees | Biopsy samples generate a separate pathology bill not in the procedure quote. | Ask whether pathology charges are bundled or billed separately. |
| Facility setting (ASC vs hospital) | ASCs are typically lower-cost than hospital outpatient departments for EGD. | Confirm whether the procedure is at an ASC or hospital outpatient department. |
| Diagnostic vs interventional | Adding biopsy, dilation or bleeding control changes the CPT code and the price. | Ask the GI doctor what additional services may be performed during the same scope. |
| Deductible and out-of-pocket maximum | EGD prices can clear a deductible in a single procedure. | Ask your insurer for the estimated patient responsibility, not just the negotiated rate. |
Example cash vs insurance scenarios
These are illustrative calculations only. Replace them with your plan and provider quote in the tool above.
| Scenario | Cash quote | Allowed amount | Deductible left | Coinsurance | Insurance estimate | Signal |
|---|---|---|---|---|---|---|
| High deductible, lower cash quote | $2,100 | $2,700 | $2,500 | 20% | $2,540 | Cash may be lower-cost, but it may not count toward the deductible. |
| Deductible already met | $2,100 | $2,700 | $0 | 20% | $540 | Insurance is usually lower-cost once the deductible is met. |
| Out-of-pocket maximum nearly met | $2,100 | $2,700 | $200 | 20% | $700 | Insurance may be close or better. |
Common Upper endoscopy CPT codes
The CPT code changes the comparison. Ask the ordering clinician or imaging provider which code will be billed.
| Code | Description | Typical use |
|---|---|---|
| 43235 | EGD, diagnostic, including collection of specimen by brushing or washing | Reflux investigation, dysphagia workup. |
| 43239 | EGD with biopsy, single or multiple | Tissue sampling for celiac disease, H. pylori, Barrett esophagus. |
| 43249 | EGD with dilation of esophagus | Esophageal strictures. |
Hospital price records (CMS MRF data)
Aggregated from each hospital’s machine-readable file (MRF) published under the CMS Hospital Price Transparency Rule (45 CFR § 180.50). Provider-specific rows include a source URL, retrieval date, and confidence rating.
What these numbers are — and what they are not. The amounts below are rates the hospital has filed with CMS: a cash / self-pay price, a payer-specific negotiated rate (often shown as a min–median–max range across the payer-plan combinations on file), or a de-identified min-negotiatedvalue. They are not patient bills: the amount a specific patient pays depends on plan, network, deductible, coinsurance, copay, separately billed professional fees, prior authorisation, and the exact CPT code billed on the day. Always verify with the provider and your insurer before booking. Some rates may be stale — each row carries the MRF retrieval date and, where available, inclusion flags for facility, professional and contrast components.
Showing 60 representative rows from 527 matched records to keep this page crawlable. The full structured extract is available through the data team.
| Provider | Location | Price type | Amount | Source | Inclusions | Checked | Confidence |
|---|---|---|---|---|---|---|---|
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $3,965 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $3,965 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $3,965 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $3,965 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $3,965 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43249 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $12,162–$18,056) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43235 | Los Angeles, CA | Cash / self-pay price | $4,878 (range $9,088–$14,143) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $14,322–$15,354) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Cedars-Sinai Medical Center CPT 43239 | Los Angeles, CA | Cash / self-pay price | $3,397 (range $14,322–$15,354) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $3,788 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43239 | Stanford, CA | Cash / self-pay price | $4,007 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43249 | Stanford, CA | Cash / self-pay price | $5,226 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Stanford Hospital CPT 43235 | Stanford, CA | Cash / self-pay price | $626 (range $140–$667) | CMS hospital MRF | not specified | 2026-05-13 | high |
| Houston Methodist Hospital CPT 43235 | Houston, TX | Cash / self-pay price | $426 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Houston Methodist Hospital CPT 43249 | Houston, TX | Cash / self-pay price | $506 | CMS hospital MRF | not specified | 2026-05-13 | high |
| Houston Methodist Hospital CPT 43239 | Houston, TX | Cash / self-pay price | $405 | CMS hospital MRF | not specified | 2026-05-13 | high |
| UT Southwestern University Hospitals CPT 43239 | Dallas, TX | Cash / self-pay price | $1,278 (range $110–$1,577) | CMS hospital MRF | not specified | 2026-05-13 | high |
| UT Southwestern University Hospitals CPT 43239 | Dallas, TX | Cash / self-pay price | $1,278 (range $110–$1,577) | CMS hospital MRF | not specified | 2026-05-13 | high |
| UT Southwestern University Hospitals CPT 43239 | Dallas, TX | Cash / self-pay price | $1,278 (range $110–$1,577) | CMS hospital MRF | not specified | 2026-05-13 | high |
Questions to ask before booking
- What CPT code will be billed (diagnostic vs biopsy vs interventional)?
- Is anesthesia included in the quoted price and is the anesthesiologist in network?
- Are pathology fees included in the quote or billed separately?
- Is the procedure at an ASC or hospital outpatient department?
- What is the facility fee, if applicable?
- If I pay cash, will the payment count toward my deductible or out-of-pocket maximum?
- What is my estimated patient responsibility if billed to my insurance?
Data-source caveats
- TreatCompare has not yet ingested nationwide hospital MRF rows for upper endoscopy.
- Anesthesia, pathology and facility components vary widely by setting and contract.
- CPT code 43235 vs 43239 has a meaningful price difference; confirm which will be billed.
- A payer-specific negotiated charge is not the same as the patient out-of-pocket amount.
According to CMS hospital price transparency data, US Upper endoscopy prices vary across hospital outpatient departments and independent imaging or surgery centres. The same scan or procedure can show a 3x to 10x price spread between facilities in the same metro area depending on payer contracts, facility fees, and whether the professional fee is bundled or billed separately.
According to standard US health-plan structure, the patient's out-of-pocket cost for a Upper endoscopy depends on remaining deductible, coinsurance percentage, in-network status, and any separately billed professional or anesthesia fees — not the headline hospital chargemaster price. The TreatCompare US cash-vs-insurance calculator estimates that responsibility from the cash quote and insurance allowed amount the patient enters.
According to CMS Hospital Price Transparency Rule (45 CFR § 180.50), every US hospital must publish a machine-readable file (MRF) of standard charges including discounted cash prices and payer-specific negotiated rates. TreatCompare US ingests these MRF files and surfaces the data per provider with the source URL and retrieval date — the price records below carry full traceability back to the original hospital file.
Sources: CMS hospital MRF data, TreatCompare US procedure price record dataset, May 2026.
Using this data?
Methodology, extracts and licensing
Main sources
- CMS Hospital Price Transparency overview
- CMS Hospital Price Transparency hospitals page
- CMSgov/hospital-price-transparency GitHub repository
- CMS CSV/JSON data dictionary and template guidance
Methodology: TreatCompare maps CMS standard-charge fields and provider cash-price fields into a consumer comparison model. This MVP explains the decision logic before full hospital MRF ingestion.
TreatCompare publishes healthcare, care-cost and treatment-pricing research for consumers, journalists, policymakers and commercial teams.
Contact TreatCompare about dataMethodology, source summaries and structured extracts: TreatCompare data team
Where to look next for Upper endoscopy pricing or a facility
Publicly-verified US healthcare directories, accreditation tools and cash-pay marketplaces. TreatCompare links to the source — booking, eligibility and pricing are handled by the destination organisation.
ASGE Find a GI SpecialistFind a facility
American Society for Gastrointestinal Endoscopy directory of GI specialists who perform colonoscopy and upper endoscopy. Filter by US state.
Visit →Healthcare BluebookPrice lookup
Independent fair-price lookup for thousands of US healthcare services. Lets you compare a quote you have received against the local fair price.
Visit →FAIR Health ConsumerPrice lookup
Free price-lookup tool maintained by the non-profit FAIR Health. Uses a database of billions of US insurance claims to show typical costs by procedure and ZIP code.
Visit →Turquoise Health ConsumerPrice lookup
Aggregates published hospital price-transparency files into a searchable price comparison by procedure, payer and ZIP code.
Visit →MDsaveCash marketplace
Pre-paid cash-bundle marketplace — patients pay an all-in price upfront and avoid the surprise-bill flow. Genuine cash-pay alternative to insurance billing.
Visit →Sidecar HealthCash marketplace
Membership health plan that pays cash directly for covered services, giving members published prices upfront. A genuine alternative model to traditional insurance.
Visit →The Leapfrog Group — Hospital SafetyHospital safety
Free hospital quality and safety ratings. Useful when deciding between a hospital outpatient department and an independent facility for the same procedure.
Visit →TreatCompare is not affiliated with these organisations and does not take a fee for linking. Verify any quoted price with your provider and insurer before booking care.
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How we label CMS, cash-pay and insurance price fields