Upper Endoscopy (EGD) With Biopsy Cost in Florida
Egd biopsy single/multiple
$1,050Hospital 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
Florida Medicare physician rate (2026)
+2.3% vs nationalAverage of 3 localities. Office range $408.78–$446.25.
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) 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 Florida
Because Florida uses multiple localities, check your ZIP code specifically, whether you are in Miami, Fort Lauderdale, West Palm Beach, Orlando, Tampa Bay, Jacksonville, or the Panhandle.
What upper endoscopy (egd) with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in Florida 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 Florida the office and hospital physician lines for this CPT differ by $296.25.
National vs Florida
Where Florida ranks for this CPT
CPT 43239 by Florida locality
| Locality | Office |
|---|---|
| miami | $446.25 |
| fort lauderdale | $430.45 |
| rest of florida | $408.78 |
PE GPCI ranges from 0.956 to 1.041 in Florida. That index is why the same CPT is not one price statewide.
Upper Endoscopy (EGD) With Biopsy and how Florida is priced
Florida is split into a handful of Medicare payment localities rather than priced statewide: Miami carries its own high-cost locality, the Fort Lauderdale area is separately priced, and the remainder of the state, from Jacksonville to the Panhandle, shares rest-of-state pricing. That structure means South Florida procedures carry higher Medicare-approved amounts than identical care in Orlando, Tampa, or rural North Florida. The Miami locality in particular ranks among the more expensive in the eastern United States. For a state with this many Medicare beneficiaries, knowing which locality your ZIP falls in is genuinely useful.
Florida has the nation's most Medicare-driven health economy, and its markets are intensely competitive in the big retiree corridors along both coasts. South Florida is known for high utilization and a dense supply of specialists, while inland and Panhandle counties can be thin on subspecialty care. Seasonal residents should note that prices follow where care is delivered, so a winter procedure in Naples prices differently than one back home up north.
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?
Other featured procedures in Florida
Upper Endoscopy (EGD) With Biopsy in other states
Upper Endoscopy (EGD) With Biopsy in Florida: questions
The 2026 Medicare physician office rate for CPT 43239 averages $428.49 across 3 Florida localities, from $408.78 in REST OF FLORIDA to $446.25 in MIAMI. The hospital physician rate averages $132.24. Enter a ZIP for the exact locality.
Yes. CMS splits Florida into 3 payment localities. For this CPT the office physician fee spans $37.47 from the lowest to highest locality. Because Florida uses multiple localities, check your ZIP code specifically, whether you are in Miami, Fort Lauderdale, West Palm Beach, Orlando, Tampa Bay, Jacksonville, or the Panhandle.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $86 for the office physician line or $26 for the hospital physician line in Florida. Medigap may cover that 20%. This is not the hospital facility fee.
No. $428.49 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. Florida ranks #38 of 51 states on the physician line (2% above the national office rate of $418.85).