CPT43239

Upper Endoscopy (EGD) With Biopsy Cost in Alaska

Egd biopsy single/multiple

$1,050Hospital outpatient total2026 Medicare, physician + facility
Hospital payments are wage-adjusted by locality, so the ZIP changes the numbers.
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Alaska Medicare physician rate (2026)

+13.5% vs national

Single statewide locality.

Alaska (Hospital)
$160.83
Facility physician fee
Private plan est.
$618–$951
~130–200% of Medicare
Cash / self-pay est.
$380–$713
~80–150% of Medicare

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.

Surgery centre, total
$621
$124 physician + $498 facility
Physician fee alone
$124
Only 12% of the hospital total

Choosing a surgery centre over a hospital saves about $429 on the Medicare allowed amount for upper endoscopy (egd) with biopsy. 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.

Your ZIP in Alaska

Look up your ZIP code to see Alaska's adjusted rates, whether you are in Anchorage, Fairbanks, Juneau, the Mat-Su Valley, or a fly-in community off the road system.

What upper endoscopy (egd) with biopsy costs at hospitals near you

Everything above is a national average. The hospital you pick in Alaska moves the bill more than anything else you control.

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Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.

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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. In Alaska the office and hospital physician lines for this CPT differ by $314.46.

National vs Alaska

National office$418.85
National hospital (physician)$123.58
Alaska vs national13% above the national office rate of $418.85

Where Alaska ranks for this CPT

Rank (lowest physician fee first)#49 of 51
Lowest stateArkansas ($367.66)
Highest stateDistrict of Columbia ($483.17)

Upper Endoscopy (EGD) With Biopsy and how Alaska is priced

Alaska stands apart in the Medicare fee schedule: it is a single statewide locality, but federal law sets a permanent 1.5 floor on its physician work adjustment, the highest geographic treatment in the country. Combined with elevated practice expense indices that reflect the real cost of running a clinic in a remote state, Alaska's Medicare-approved amounts are consistently the highest of any state. Every community from Anchorage to the smallest bush village prices off the same locality, so the premium applies statewide rather than only in the cities.

Anchorage holds most of the state's specialists, and Fairbanks and Juneau add regional capacity, but many Alaskans still fly to Anchorage or even Seattle for complex procedures. Travel and lodging can rival the medical bill itself for residents of remote communities, which makes planning ahead unusually important here. Tribal health facilities also play a large role in care delivery across much of the state.

This procedure: This is the same upper endoscopy camera exam of the esophagus, stomach, and duodenum, but with the physician taking one or more small tissue samples through the scope using tiny forceps. Biopsies are painless and are taken to test for conditions such as H. pylori infection, celiac disease, Barrett's esophagus, or inflammation. The exam runs 10 to 20 minutes under IV sedation, and recovery is the same as a diagnostic EGD: home the same day with a driver.

What Is Upper Endoscopy (EGD) With Biopsy?

This is the same upper endoscopy camera exam of the esophagus, stomach, and duodenum, but with the physician taking one or more small tissue samples through the scope using tiny forceps. Biopsies are painless and are taken to test for conditions such as H. pylori infection, celiac disease, Barrett's esophagus, or inflammation. The exam runs 10 to 20 minutes under IV sedation, and recovery is the same as a diagnostic EGD: home the same day with a driver.

What Affects the Cost

  • Pathology is the defining extra cost of this code: each biopsy jar processed and read by the lab generates its own charge, and multiple sites mean multiple jars.
  • The facility fee difference between hospital outpatient departments and freestanding endoscopy centers dwarfs most other line items.
  • Separate anesthesia billing for propofol sedation adds an independent professional charge.
  • Testing biopsies for H. pylori or celiac disease may involve special stains that increase the lab bill.
  • The physician fee for 43239 is higher than the no-biopsy code 43235, reflecting the sampling work.

Questions to Ask Before Booking

  • 1.How many biopsy specimens do you expect to take, and what does the lab charge per specimen?
  • 2.Which pathology lab reads the samples and is it in my network?
  • 3.What is the total estimate across physician, facility, anesthesia, and pathology bills?
  • 4.Would a freestanding endoscopy center lower the facility portion of my cost?
  • 5.If you find something needing treatment during the exam, how could the code and price change?

Upper Endoscopy (EGD) With Biopsy in Alaska: questions

Alaska is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 43239 is $475.29 in an office and $160.83 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.

Not on the physician fee schedule. Alaska uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.

After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $95 for the office physician line or $32 for the hospital physician line in Alaska. Medigap may cover that 20%. This is not the hospital facility fee.

No. $475.29 is only the physician's share. Adding Medicare's facility payment brings the total to about $1,050 in a hospital outpatient department, or about $621 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. Alaska ranks #49 of 51 states on the physician line (13% above the national office rate of $418.85).

Data source: 2026 Medicare Physician Fee Schedule (CMS PPRRVU26B, released March 2026). Conversion factor: $33.4009. Prices shown are Medicare allowed amounts for the physician service and may not match what you are billed. Private insurance and self-pay ranges, when shown, are labeled estimates (typical multiples of Medicare), not quotes. This site is an independent cost tool, not medical advice.