Upper Endoscopy (EGD) Cost
Egd diagnostic brush wash
$1,037Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $429 on the Medicare allowed amount for upper endoscopy (egd). Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough — no account, no insurance card.
What upper endoscopy (egd) costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $212.09.
How CMS prices CPT 43235
Work is about 21% of the office total RVU; practice expense is about 76%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $322.65. Hospital (facility) physician rate: $110.56.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $65 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
What Is Upper Endoscopy (EGD)?
An upper endoscopy, or EGD, passes a thin flexible camera through the mouth to examine the esophagus, stomach, and the first part of the small intestine. It investigates problems like persistent heartburn, swallowing difficulty, unexplained anemia, or upper abdominal pain. You receive sedation through an IV, the exam itself takes 10 to 20 minutes, and you go home the same day once the sedation wears off, needing a driver.
What Affects the Cost
- –The choice between a hospital outpatient department and a freestanding endoscopy center is the single biggest price lever.
- –Sedation billed by a separate anesthesia provider, especially propofol given by an anesthesiologist or CRNA, adds a significant independent charge.
- –This code is the diagnostic-only exam; if the doctor takes even one biopsy the procedure is recoded to 43239 at a higher rate plus lab fees.
- –Pre-procedure consultation visits with the gastroenterologist are billed separately from the endoscopy itself.
- –Facility fees vary more than physician fees, so the same doctor can cost very different amounts at different locations.
How It Is Billed
CPT 43235 covers the gastroenterologist's fee for a diagnostic look with no tissue sampling; the endoscopy center or hospital bills a separate facility fee that is usually larger, and anesthesia is a third claim when a dedicated provider gives sedation. If findings prompt biopsies, dilation, or removal of anything, the code changes and pathology charges follow. It is common to receive three or four separate bills for one 15-minute exam: physician, facility, anesthesia, and sometimes pathology.
Insurance & Coverage Notes
Diagnostic EGD for symptoms is covered as medical care subject to deductible and coinsurance; unlike colonoscopy there is no preventive screening benefit that makes it free, so expect to pay your normal share. Many commercial plans require prior authorization for non-emergency endoscopy, and some steer members toward lower-cost freestanding centers. Verify that the anesthesia provider is in network, since endoscopy sedation has historically been a common source of surprise bills.
Questions to Ask Before Booking
- 1.Can this be scheduled at a freestanding endoscopy center rather than the hospital, and what is the facility fee at each?
- 2.Who provides the sedation, what type is used, and are they in my network?
- 3.If you take biopsies during the exam, how much does the procedure code and pathology add?
- 4.Is prior authorization required and has it been obtained?
- 5.What is the all-in estimate including physician, facility, anesthesia, and pathology?
Upper Endoscopy (EGD) (CPT 43235): questions
The 2026 national Medicare physician rate for CPT 43235 is $322.65 in an office and $110.56 in a hospital. Enter a ZIP code to apply the geographic adjustment for your locality.
Medicare uses a different practice-expense RVU in a facility. For CPT 43235 that produces an office rate of $322.65 and a hospital physician rate of $110.56 (a $212.09 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
An upper endoscopy, or EGD, passes a thin flexible camera through the mouth to examine the esophagus, stomach, and the first part of the small intestine. It investigates problems like persistent heartburn, swallowing difficulty, unexplained anemia, or upper abdominal pain. You receive sedation through an IV, the exam itself takes 10 to 20 minutes, and you go home the same day once the sedation wears off, needing a driver. CMS bills it as “Egd diagnostic brush wash.”
Not on its own. $322.65 is the physician allowed amount. Medicare also pays the facility, which takes the total to about $1,037 in a hospital outpatient department or about $608 at an ambulatory surgery centre. Anesthesia, pathology and imaging interpretation billed under other codes are separate again. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.