Upper Endoscopy (EGD) With Biopsy Cost in Michigan
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
Michigan Medicare physician rate (2026)
-4.0% vs nationalAverage of 2 localities. Office range $391.13–$413.41.
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 Michigan
Enter your ZIP code to see whether Detroit-area or rest-of-state rates apply, from Detroit, Ann Arbor, and Flint to Grand Rapids, Lansing, Traverse City, and the Upper Peninsula.
What upper endoscopy (egd) with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in Michigan 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 Michigan the office and hospital physician lines for this CPT differ by $277.26.
National vs Michigan
Where Michigan ranks for this CPT
CPT 43239 by Michigan locality
| Locality | Office |
|---|---|
| detroit | $413.41 |
| rest of michigan | $391.13 |
PE GPCI ranges from 0.913 to 0.965 in Michigan. That index is why the same CPT is not one price statewide.
Upper Endoscopy (EGD) With Biopsy and how Michigan is priced
Michigan divides into a Detroit metro locality and a rest-of-state locality, so the fee schedule prices southeast Michigan above Grand Rapids, Lansing, and the northern reaches. Detroit's locality reflects the metro's higher wage and cost structure, while everywhere else in the Lower and Upper Peninsulas shares one set of lower adjustments. The result is a simple two-tier state where the main question is whether your care happens inside the Detroit area or out. Upper Peninsula residents, despite their remoteness, price the same as Grand Rapids under the rest-of-state locality.
Southeast Michigan concentrates the state's academic medicine and largest hospital systems, with Ann Arbor's university medical center serving as a top national referral destination. West Michigan has built a strong hospital hub in Grand Rapids, while the Upper Peninsula's small population depends on a few regional hospitals and sometimes crosses into Wisconsin for care. Auto-industry benefit legacies still shape how many Michiganders experience health coverage.
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 Michigan
Upper Endoscopy (EGD) With Biopsy in other states
Upper Endoscopy (EGD) With Biopsy in Michigan: questions
The 2026 Medicare physician office rate for CPT 43239 averages $402.27 across 2 Michigan localities, from $391.13 in REST OF MICHIGAN to $413.41 in DETROIT. The hospital physician rate averages $125.01. Enter a ZIP for the exact locality.
Yes. CMS splits Michigan into 2 payment localities. For this CPT the office physician fee spans $22.28 from the lowest to highest locality. Enter your ZIP code to see whether Detroit-area or rest-of-state rates apply, from Detroit, Ann Arbor, and Flint to Grand Rapids, Lansing, Traverse City, and the Upper Peninsula.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $80 for the office physician line or $25 for the hospital physician line in Michigan. Medigap may cover that 20%. This is not the hospital facility fee.
No. $402.27 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. Michigan ranks #22 of 51 states on the physician line (4% below the national office rate of $418.85).