Cost of a EGD with Biopsy Visit
in Ohio
Reviewed by Momentary Medical Group West PC
Ohio's diverse healthcare market, anchored by major health systems like Cleveland Clinic and Ohio State Wexner Medical Center, offers patients access to nearly 4,800 providers performing upper endoscopy with biopsy procedures. Patients typically pay between $85 and $621 for an EGD with Biopsy in Ohio, with a median negotiated rate of $220 across the state's insurance networks. The growing ambulatory surgery center market in Ohio has created more cost-effective options for patients seeking these diagnostic procedures, allowing them to browse all qualified providers throughout the state.
Average
$309
Median
$220
Lowest
$85
Highest
$621
Providers
4,786
43% below national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Ohio?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $85 | $326 | $565 | 4,648 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $85 | $319 | $709 | 4,738 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $191 | $407 | $751 | 4,236 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $77 | $195 | $474 | 4,445 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $11 | $19 | $85 | 6,459 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $52 | $132 | $351 | 5,273 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $32 | $87 | $211 | 4,369 |
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 Ohio
Ohio's healthcare costs run approximately 2% below the national average, reflecting the state's moderate cost of living and competitive provider market. The state's mix of major metropolitan areas and extensive rural regions creates distinct cost patterns, with Cleveland, Columbus, and Cincinnati commanding higher rates than smaller communities.
Urban vs. Rural Provider Availability
Ohio's three major metropolitan areas concentrate most specialist providers, creating cost disparities where rural patients may travel to cities for procedures or pay premium rates for limited local options. The state's Appalachian region faces particular challenges with provider shortages, though telemedicine initiatives are expanding access to pre-procedure consultations.
Facility Type and Overhead Costs
Hospital-based outpatient departments in Ohio typically charge facility fees in addition to physician fees, while independent ambulatory surgery centers often provide more transparent, bundled pricing. Major health systems like OhioHealth and Kettering Health dominate certain regions, influencing local pricing through their market presence and negotiating power with insurers.
Insurance Market Competition in Ohio
The presence of regional insurer Medical Mutual alongside national players like Anthem and UnitedHealthcare creates moderate competition in Ohio's insurance market. This competitive environment helps keep negotiated rates reasonable, though rural areas may have fewer insurer options, potentially leading to higher out-of-pocket costs in those regions.
Physician Supply and Demand in Ohio
With nearly 4,800 providers offering EGD with Biopsy services across Ohio, the state maintains adequate specialist availability relative to its population. This healthy provider supply helps contain costs and reduces wait times, particularly in metropolitan areas, though rural regions still face access challenges that can drive up local 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 Ohio
What is the average cost of a EGD with Biopsy visit in Ohio without insurance?
Does Ohio Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Ohio?
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 Ohio?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Ohio?
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 |