Upper Endoscopy (EGD) Cost in California
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
California Medicare physician rate (2026)
+13.6% vs nationalAverage of 29 localities. Office range $343.76–$435.38.
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.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What upper endoscopy (egd) costs at hospitals near you
Everything above is a national average. The hospital you pick in California 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. In California the office and hospital physician lines for this CPT differ by $250.96.
National vs California
Where California ranks for this CPT
CPT 43235 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $435.38 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $434.27 |
| san francisco-oakland-berkeley (marin cnty) | $425.85 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $425.58 |
| napa | $401.39 |
| vallejo | $401.00 |
| santa rosa-petaluma | $377.18 |
| santa cruz-watsonville | $373.36 |
| san diego-chula vista-carlsbad | $369.34 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $367.86 |
| oxnard-thousand oaks-ventura | $366.40 |
| santa maria-santa barbara | $361.76 |
| sacramento-roseville-folsom | $361.57 |
| salinas | $360.24 |
| san luis obispo-paso robles | $354.35 |
| riverside-san bernardino-ontario | $346.36 |
| bakersfield | $344.48 |
| el centro | $343.80 |
| chico | $343.76 |
| fresno | $343.76 |
| hanford-corcoran | $343.76 |
| madera | $343.76 |
| merced | $343.76 |
| modesto | $343.76 |
| redding | $343.76 |
| stockton | $343.76 |
| visalia | $343.76 |
| yuba city | $343.76 |
| rest of california | $343.76 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Upper Endoscopy (EGD) and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: 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 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.
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?
Other featured procedures in California
Upper Endoscopy (EGD) in other states
Upper Endoscopy (EGD) in California: questions
The 2026 Medicare physician office rate for CPT 43235 averages $366.60 across 29 California localities, from $343.76 in CHICO to $435.38 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $115.64. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $91.62 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $73 for the office physician line or $23 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $366.60 is only the physician's share. Adding Medicare's facility payment brings the total to about $1,037 in a hospital outpatient department, or about $608 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. California ranks #49 of 51 states on the physician line (14% above the national office rate of $322.65).