Cost of a EGD with Biopsy Visit
in Illinois
Reviewed by Momentary Medical Group West PC
Illinois's healthcare market, dominated by the Chicago metropolitan area, offers patients access to over 5,800 providers offering EGD with Biopsy procedures across the state. Patients typically pay between $70 and $696 for an EGD with Biopsy, with a median cost of $339 based on negotiated insurance rates. With Illinois's expanded Medicaid coverage and competitive insurance landscape featuring BCBS IL, UHC, and Aetna, patients can browse all EGD with Biopsy providers throughout Illinois to find quality care at transparent prices.
Average
$368
Median
$339
Lowest
$70
Highest
$696
Providers
5,884
32% below national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Illinois?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $85 | $344 | $901 | 4,773 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $80 | $441 | $1,147 | 4,920 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $220 | $462 | $944 | 5,408 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $118 | $290 | $534 | 3,608 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $17 | $24 | $85 | 10,197 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $74 | $178 | $378 | 6,654 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $45 | $101 | $257 | 6,504 |
Important: These are cost estimates only — not a quote and not medical advice.
The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 43239 — EGD with biopsy). They represent what a patient might pay without insurance.
Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.
This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.
Where this data comes from & what CPT 43239 covers
Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 43239 (EGD with biopsy), as mandated by the CMS Price Transparency Rule.
What CPT 43239 covers: the provider's professional fee for upper endoscopy with biopsy. It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.
How to read this data
Negotiated Rate
The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.
P5, Median, P95
P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.
What this does not tell you
These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.
Why EGD with Biopsy Visit Costs Vary Across Illinois
Illinois healthcare costs run approximately 10% above national averages, driven primarily by the Chicago metropolitan area's premium pricing and the state's concentrated provider networks. The stark divide between Chicago's abundant specialist options and rural Illinois's limited access creates significant cost and availability disparities statewide.
Urban vs. Rural Provider Availability
Chicago's dense concentration of gastroenterologists contrasts sharply with rural counties where patients may travel hours to reach the nearest EGD with Biopsy provider. This geographic imbalance allows urban practices to command higher rates while rural patients face both travel costs and limited scheduling options.
Facility Type and Overhead Costs
Hospital-owned outpatient centers dominate Illinois's gastroenterology landscape, particularly around major health systems like Northwestern Medicine and Rush University Medical Center. These facilities typically charge higher facility fees compared to independent ambulatory surgery centers, though they may offer more comprehensive backup services.
Insurance Market Competition in Illinois
The Illinois market sees moderate competition between BCBS IL, UHC, and Aetna, though BCBS maintains significant market share particularly in rural areas. This concentration gives dominant insurers stronger negotiating power with providers, potentially keeping some rates in check while limiting patient choice in provider networks.
Physician Supply and Demand in Illinois
With 5,884 providers offering EGD with Biopsy procedures statewide, Illinois maintains adequate specialist supply in urban areas but significant shortages in rural regions. This uneven distribution creates longer wait times and higher costs in underserved areas while maintaining competitive pricing in Chicago and surrounding suburbs.
Jayant Panwar
CEO, Momentary Labs · San Francisco, CA
Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.
The cost figures on this page reflect his ongoing work to make this data accessible to patients.
Frequently Asked Questions — EGD with Biopsy Costs in Illinois
What is the average cost of a EGD with Biopsy visit in Illinois without insurance?
Does Illinois Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Illinois?
What is the difference in cost between an initial consultation and a follow-up visit?
Can I use an HSA or FSA to pay for a EGD with Biopsy visit in Illinois?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Illinois?
Click a state to compare costs
Average Visit Cost
Office visit (CPT 43239)
Compare With Other States
| Rank | State | Average↓ |
|---|---|---|
| 1 | Wisconsin Range: $116 – $5,357 | $2,029 |
| 2 | North Dakota Range: $181 – $2,396 | $1,658 |
| 3 | Minnesota Range: $90 – $2,396 | $1,627 |
| 4 | South Dakota Range: $85 – $2,396 | $938 |
| 5 | Massachusetts Range: $80 – $1,654 | $747 |
| 6 | New York Range: $166 – $1,647 | $743 |
| 7 | New Hampshire Range: $341 – $1,085 | $715 |
| 8 | Rhode Island Range: $80 – $1,647 | $715 |
| 9 | Connecticut Range: $85 – $1,647 | $711 |
| 10 | Delaware Range: $80 – $1,647 | $684 |
| 11 | West Virginia Range: $80 – $1,647 | $675 |
| 12 | Pennsylvania Range: $80 – $1,647 | $666 |
| 13 | Maine Range: $404 – $783 | $631 |
| 14 | Nebraska Range: $195 – $902 | $629 |
| 15 | Oregon Range: $80 – $1,352 | $553 |
| 16 | Vermont Range: $273 – $907 | $552 |
| 17 | Wyoming Range: $173 – $1,151 | $549 |
| 18 | California Range: $80 – $1,352 | $542 |
| 19 | Georgia Range: $85 – $1,084 | $522 |
| 20 | Iowa Range: $85 – $902 | $516 |
| 21 | New Jersey Range: $83 – $1,165 | $508 |
| 22 | District of Columbia Range: $86 – $995 | $504 |
| 23 | North Carolina Range: $80 – $1,088 | $495 |
| 24 | Missouri Range: $130 – $712 | $436 |
| 25 | Utah Range: $80 – $820 | $428 |
| 26 | New Mexico Range: $90 – $834 | $424 |
| 27 | Washington Range: $80 – $954 | $423 |
| 28 | Hawaii Range: $80 – $903 | $411 |
| 29 | Maryland Range: $121 – $810 | $401 |
| 30 | Indiana Range: $80 – $810 | $399 |
| 31 | Colorado Range: $85 – $829 | $383 |
| 32 | Kentucky Range: $60 – $830 | $370 |
| 33 | Illinois Range: $70 – $696 | $368 |
| 34 | Arkansas Range: $85 – $712 | $361 |
| 35 | Virginia Range: $90 – $728 | $358 |
| 36 | Idaho Range: $80 – $802 | $356 |
| 37 | Michigan Range: $80 – $685 | $341 |
| 38 | Mississippi Range: $114 – $621 | $340 |
| 39 | Kansas Range: $130 – $526 | $333 |
| 40 | Louisiana Range: $85 – $634 | $331 |
| 41 | Texas Range: $80 – $649 | $320 |
| 42 | Ohio Range: $85 – $621 | $309 |
| 43 | South Carolina Range: $80 – $627 | $306 |
| 44 | Alabama Range: $80 – $566 | $305 |
| 45 | Nevada Range: $85 – $571 | $304 |
| 46 | Tennessee Range: $85 – $604 | $296 |
| 47 | Oklahoma Range: $85 – $569 | $264 |
| 48 | Alaska Range: $80 – $606 | $255 |
| 49 | Florida Range: $35 – $659 | $250 |
| 50 | Arizona Range: $81 – $493 | $245 |
| 51 | Montana Range: $80 – $523 | $228 |