Cost of a EGD with Biopsy Visit
in Maine
Reviewed by Momentary Medical Group West PC
Maine's aging population and higher rates of digestive health concerns drive significant demand for specialized gastroenterology services across the state's largely rural healthcare landscape. Patients seeking an EGD with Biopsy in Maine typically pay between $404 and $783, with a median out-of-pocket cost of $707 based on actual negotiated rates from over 1,500 active providers statewide. The state's network of regional medical centers and specialty clinics offers patients multiple options for accessing these essential diagnostic procedures throughout Maine's diverse geographic regions.
Average
$631
Median
$707
Lowest
$404
Highest
$783
Providers
1,551
17% above national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Maine?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $220 | $561 | $674 | 1,544 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $456 | $799 | $887 | 1,549 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $494 | $868 | $926 | 1,540 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $333 | $562 | $583 | 1,527 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $22 | $28 | $35 | 1,738 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $95 | $260 | $394 | 1,718 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $79 | $179 | $272 | 1,708 |
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 Maine
Healthcare costs in Maine run approximately 12% above the national average, reflecting the state's rural geography, aging population, and limited provider competition in many regions. The state's scattered population across vast rural areas creates unique access challenges that influence both pricing and availability of specialized gastroenterology services.
Urban vs. Rural Provider Availability
Maine's gastroenterology providers are heavily concentrated in the Portland metro area and coastal regions, leaving rural counties like Aroostook and Washington with limited local access. This geographic disparity forces many patients to travel significant distances for care, while also allowing urban providers to maintain higher pricing due to limited rural alternatives.
Facility Type and Overhead Costs
Hospital-based outpatient clinics affiliated with Maine Medical Center and other health systems typically charge higher facility fees than independent gastroenterology practices. The state's mix of academic medical centers, community hospitals, and freestanding endoscopy centers creates significant cost variation depending on where patients receive their EGD with Biopsy procedure.
Insurance Market Competition in Maine
With Anthem, Harvard Pilgrim, and UnitedHealthcare controlling most of the market, Maine has moderate insurer competition that affects negotiated rates differently across regions. Rural areas often have fewer insurer options, potentially leading to higher costs, while the Portland market sees more competitive pricing due to greater insurer presence.
Physician Supply and Demand in Maine
Maine's network of over 1,500 providers offering EGD with Biopsy services suggests adequate supply in aggregate, but distribution remains uneven with rural shortages driving longer wait times and higher costs. The state's aging physician workforce and challenges recruiting specialists to rural areas continue to influence both access and pricing patterns statewide.
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 Maine
What is the average cost of a EGD with Biopsy visit in Maine without insurance?
Does Maine Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Maine?
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 Maine?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Maine?
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 |