How Much Does an Upper Endoscopy (EGD) Cost in Missouri?
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$1,037Hospital outpatient total2026 Medicare, physician + facilityUnder 2026 Medicare rates, an upper endoscopy (EGD) costs about $1,037 in total at a hospital outpatient department or about $608 at an ambulatory surgery center, counting both the physician and the facility (national rates). The physician's own fee in Missouri averages $108, from $106 to $109 across 3 Medicare localities.
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Missouri Medicare physician rate (2026)
-6.3% vs nationalAverage of 3 localities. Office range $288.43–$310.84.
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 center 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 center.
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 Missouri
Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What upper endoscopy (EGD) costs at hospitals near you
Everything above is a national average. The hospital you pick in Missouri 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 center 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 Missouri the office and hospital physician lines for this CPT differ by $194.63.
National vs Missouri
Where Missouri ranks for this CPT
CPT 43235 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $310.84 |
| metropolitan kansas city | $307.43 |
| rest of missouri | $288.43 |
PE GPCI ranges from 0.862 to 0.952 in Missouri. That index is why the same CPT is not one price statewide.
Upper Endoscopy (EGD) and how Missouri is priced
Missouri is a three-locality state: metropolitan St. Louis and metropolitan Kansas City are each priced separately, and everywhere else falls into a rest-of-state locality with lower geographic adjustments. Both metro localities approve higher amounts than outstate Missouri, and the Kansas City locality applies only to the Missouri side of that metro, since the Kansas side prices under Kansas's statewide locality. Springfield, Columbia, and the rural counties all share rest-of-state factors. The metro-versus-outstate gap is the main pricing story here.
St. Louis and Kansas City hold the state's academic medical centers and most of its specialty depth, drawing patients from far beyond Missouri's borders, including southern Illinois and eastern Kansas. Outstate Missouri is served by regional hubs in Springfield, Columbia, and Cape Girardeau, with the Ozarks and Bootheel among the harder places to reach specialty care. Rural hospital viability has been a persistent concern across the state.
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 Missouri
Upper Endoscopy (EGD) in other states
Upper Endoscopy (EGD) in Missouri: questions
Under 2026 Medicare rates, an upper endoscopy (EGD) costs about $1,037 in total at a hospital outpatient department or about $608 at an ambulatory surgery center, counting both the physician and the facility (national rates). The physician's own fee in Missouri averages $108, from $106 to $109 across 3 Medicare localities. Enter a ZIP for the exact Missouri locality.
Yes. CMS splits Missouri into 3 payment localities. For this CPT the office physician fee spans $22.41 from the lowest to highest locality. Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $60 for the office physician line or $22 for the hospital physician line in Missouri. Medigap may cover that 20%. This is not the hospital facility fee.
No. $107.60 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 center. Anesthesia, pathology and other codes billed the same day are extra. Missouri ranks #15 of 51 states on the physician line (6% below the national office rate of $322.65).