Cost of a EGD with Biopsy Visit
in Massachusetts
Reviewed by Momentary Medical Group West PC
Massachusetts leads the nation in healthcare innovation, yet patients still face significant cost variation for specialized procedures like EGD with Biopsy visits. Based on negotiated insurance rates across 1,412 active providers, patients typically pay between $80 and $1,654, with a median out-of-pocket cost of $508. The state's concentration of world-class medical institutions and specialists means patients have exceptional access to quality care, though costs average 25% above national levels.
Average
$747
Median
$508
Lowest
$80
Highest
$1,654
Providers
1,412
39% above national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Massachusetts?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $113 | $500 | $1,830 | 1,075 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $80 | $600 | $2,117 | 1,381 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $80 | $735 | $2,338 | 1,352 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $159 | $457 | $1,259 | 1,065 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $14 | $14 | $80 | 1,987 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $77 | $218 | $677 | 1,520 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $52 | $80 | $328 | 1,764 |
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 Massachusetts
Massachusetts ranks among the most expensive states for healthcare, with EGD with Biopsy costs running approximately 25% above national averages. The state's concentration of prestigious medical institutions, high cost of living, and regulatory environment all contribute to elevated healthcare pricing compared to other regions.
Urban vs. Rural Provider Availability
The Boston metropolitan area concentrates most gastroenterology specialists, while western Massachusetts counties like Berkshire and Franklin have limited options, often requiring 60+ mile trips for specialty care. This geographic disparity creates cost pressures as rural patients may need to seek care at higher-priced urban academic centers.
Facility Type and Overhead Costs
Major health systems like Mass General Brigham and Beth Israel Lahey Health operate numerous hospital-based endoscopy centers with higher facility fees than independent practices. These academic medical centers often charge premium rates due to their research missions and complex case mix, though they offer cutting-edge technology and subspecialty expertise.
Insurance Market Competition in Massachusetts
The insurance landscape is dominated by just three major players - BCBS MA, Tufts, and Harvard Pilgrim - creating a relatively concentrated market. This limited competition can result in higher negotiated rates compared to states with more insurer options, though Massachusetts's regulatory oversight helps moderate extreme pricing.
Physician Supply and Demand in Massachusetts
With 1,412 active EGD with Biopsy providers serving 7 million residents, Massachusetts has strong specialist density compared to national averages. However, demand remains high due to the aging population and preference for preventive care, which can create scheduling delays of 2-4 weeks at popular practices.
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 Massachusetts
What is the average cost of a EGD with Biopsy visit in Massachusetts without insurance?
Does Massachusetts Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Massachusetts?
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 Massachusetts?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Massachusetts?
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 |