Cost of a EGD with Biopsy Visit
in New Mexico
Reviewed by Momentary Medical Group West PC
New Mexico's rural geography creates unique challenges for accessing specialized gastroenterology services, with many patients traveling significant distances for EGD with Biopsy procedures. Based on transparency data from major insurers including BCBS New Mexico, UHC, and Molina, patients typically encounter negotiated rates between $90 and $834 across the state's 1,281 participating providers. The Land of Enchantment's expanded Medicaid program and relatively lower healthcare costs compared to neighboring states help make these diagnostic procedures more accessible to residents throughout the Rio Grande Valley and high desert regions.
Average
$424
Median
$347
Lowest
$90
Highest
$834
Providers
1,281
21% below national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in New Mexico?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $168 | $384 | $954 | 1,258 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $90 | $450 | $1,136 | 1,250 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $265 | $545 | $1,278 | 1,233 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $141 | $308 | $724 | 1,194 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $15 | $28 | $83 | 1,322 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $80 | $211 | $440 | 1,305 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $48 | $106 | $292 | 1,270 |
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 New Mexico
Healthcare costs in New Mexico run approximately 3% below national averages, reflecting the state's lower cost of living and reduced provider overhead compared to coastal regions. The state's vast rural territories and concentrated population centers create distinct pricing patterns that affect EGD with Biopsy accessibility and affordability across different regions.
Urban vs. Rural Provider Availability
New Mexico's geography creates stark disparities in gastroenterology access, with most EGD with Biopsy specialists concentrated in the Albuquerque metropolitan area and Santa Fe corridor. Rural communities like those in the Four Corners region or southeastern plains often require patients to travel 100+ miles for specialized endoscopic procedures. This geographic concentration allows urban practices to maintain competitive pricing through higher patient volumes, while rural hospitals may charge premium rates due to limited local alternatives and higher per-procedure overhead costs.
Facility Type and Overhead Costs
Hospital-based outpatient endoscopy centers in New Mexico typically charge higher facility fees than independent ambulatory surgery centers due to their broader overhead structure and emergency preparedness requirements. Presbyterian Healthcare Services and University of New Mexico Health System represent the state's largest integrated networks, with standardized pricing across their multiple locations. Smaller community hospitals in places like Roswell or Silver City may have higher per-procedure costs due to lower patient volumes but often provide more personalized service and shorter wait times.
Insurance Market Competition in New Mexico
New Mexico's insurance market shows limited competition with BCBS New Mexico, UHC, and Molina holding dominant positions, resulting in less aggressive rate negotiations than seen in more competitive state markets. Presbyterian Health Plan maintains a strong regional presence with established provider relationships that can offer competitive rates for EGD with Biopsy procedures. The concentrated market structure means switching insurers during open enrollment periods can significantly impact out-of-pocket costs, as different plans have varying negotiated rates with the same gastroenterology practices.
Physician Supply and Demand in New Mexico
With 1,281 providers participating in EGD with Biopsy services across New Mexico's relatively small population, the state maintains adequate specialist access in urban areas while facing shortages in rural regions. This supply-demand imbalance contributes to longer wait times and potentially higher costs in underserved areas, particularly in the northwestern and southeastern counties. The University of New Mexico's medical school helps train gastroenterologists, but many graduates leave for higher-paying opportunities in other states, creating ongoing workforce challenges that can affect both availability and pricing.
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 New Mexico
What is the average cost of a EGD with Biopsy visit in New Mexico without insurance?
Does New Mexico Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in New Mexico?
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 New Mexico?
How does telemedicine affect the cost of seeing a EGD with Biopsy in New Mexico?
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 |