Cost of a EGD with Biopsy Visit
in Kentucky
Reviewed by Momentary Medical Group West PC
Kentucky's healthcare system serves both the urban centers of Louisville and Lexington alongside rural Appalachian communities, creating diverse pricing structures for EGD with Biopsy procedures across the state. Based on negotiated insurance rates, patients typically pay between $60 and $830 for an EGD with Biopsy, with costs running approximately 46% below national averages. Kentucky maintains 282 active providers performing these procedures, giving patients substantial options when selecting an in-network specialist.
Average
$370
Median
$220
Lowest
$60
Highest
$830
Providers
282
31% below national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Kentucky?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $85 | $324 | $814 | 243 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $80 | $322 | $917 | 270 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $202 | $421 | $1,136 | 210 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $106 | $249 | $631 | 191 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $14 | $80 | $88 | 945 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $64 | $152 | $477 | 283 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $44 | $92 | $229 | 248 |
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 Kentucky
Kentucky's healthcare costs run approximately 5% below national averages, reflecting the state's lower cost of living and competitive insurance market. The Commonwealth's mix of urban medical centers and rural access challenges creates distinct pricing patterns across different regions.
Urban vs. Rural Provider Availability
Louisville and Lexington concentrate most of Kentucky's gastroenterologists, while residents of eastern Kentucky's mountain counties often travel significant distances for EGD with Biopsy procedures. This geographic disparity can increase total costs when factoring in travel expenses, though rural hospitals sometimes offer competitive self-pay rates to attract patients.
Facility Type and Overhead Costs
Hospital-owned endoscopy centers in Kentucky typically charge facility fees ranging from $500-1,200, while independent gastroenterology practices often provide the same procedures for 30-50% less. Major health systems like Norton Healthcare and Baptist Health dominate the Louisville market, while UK HealthCare anchors central Kentucky's academic medicine landscape.
Insurance Market Competition in Kentucky
Anthem Blue Cross Blue Shield holds significant market share in Kentucky, competing with UnitedHealthcare and Humana for both individual and employer-sponsored plans. This three-way competition has resulted in favorable negotiated rates for endoscopic procedures, with most insurers covering EGD with Biopsy visits under specialist copay structures.
Physician Supply and Demand in Kentucky
With 282 active providers performing EGD with Biopsy procedures, Kentucky maintains adequate specialist availability in urban areas but faces shortages in rural regions. The concentration of gastroenterologists in Louisville and Lexington creates competitive pricing in these markets, while limited rural access can drive up costs for patients in outlying areas.
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 Kentucky
What is the average cost of a EGD with Biopsy visit in Kentucky without insurance?
Does Kentucky Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Kentucky?
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 Kentucky?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Kentucky?
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 |