Upper Endoscopy (EGD) With Biopsy Cost in Massachusetts
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
Massachusetts Medicare physician rate (2026)
+10.0% vs nationalAverage of 2 localities. Office range $435.86–$485.46.
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 Massachusetts
Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
What upper endoscopy (egd) with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in Massachusetts 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.
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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 Massachusetts the office and hospital physician lines for this CPT differ by $331.73.
National vs Massachusetts
Where Massachusetts ranks for this CPT
CPT 43239 by Massachusetts locality
| Locality | Office |
|---|---|
| metropolitan boston | $485.46 |
| rest of massachusetts | $435.86 |
PE GPCI ranges from 1.053 to 1.194 in Massachusetts. That index is why the same CPT is not one price statewide.
Upper Endoscopy (EGD) With Biopsy and how Massachusetts is priced
Massachusetts is priced through two localities: metro Boston and the rest of the state. Boston's locality carries clearly higher geographic adjustments, reflecting some of the highest medical wages and office costs in the nation, while Worcester, Springfield, and the Cape share the lower rest-of-state factors. The split means the fee schedule itself acknowledges what everyone in the state already knows about Boston prices. Even so, rest-of-state Massachusetts still prices above most of the country.
Boston has arguably the densest concentration of academic medical centers anywhere, and its teaching hospitals pull referrals from all of New England and beyond. That prestige comes with a high-cost market structure that state policymakers have scrutinized for years. Western Massachusetts operates more like a regional market centered on Springfield, and Cape and islands residents contend with seasonal capacity strain.
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 Massachusetts
Upper Endoscopy (EGD) With Biopsy in other states
Upper Endoscopy (EGD) With Biopsy in Massachusetts: questions
The 2026 Medicare physician office rate for CPT 43239 averages $460.66 across 2 Massachusetts localities, from $435.86 in REST OF MASSACHUSETTS to $485.46 in METROPOLITAN BOSTON. The hospital physician rate averages $128.93. Enter a ZIP for the exact locality.
Yes. CMS splits Massachusetts into 2 payment localities. For this CPT the office physician fee spans $49.60 from the lowest to highest locality. Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $92 for the office physician line or $26 for the hospital physician line in Massachusetts. Medigap may cover that 20%. This is not the hospital facility fee.
No. $460.66 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. Massachusetts ranks #45 of 51 states on the physician line (10% above the national office rate of $418.85).