Cost of a EGD with Biopsy Visit
in Pennsylvania
Reviewed by Momentary Medical Group West PC
Pennsylvania's healthcare market features significant cost variations for EGD with Biopsy procedures across its diverse urban and rural regions, with concentrated provider networks in Philadelphia and Pittsburgh driving competitive pricing. Patients typically pay between $80 and $1,647 for an EGD with Biopsy, with a median out-of-pocket cost of $273 based on negotiated insurance rates from 1,592 active providers statewide. Pennsylvania maintains a robust network of gastroenterology specialists, allowing patients to browse multiple provider options when seeking upper endoscopy services with biopsy capabilities.
Average
$666
Median
$273
Lowest
$80
Highest
$1,647
Providers
1,592
24% above national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Pennsylvania?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $85 | $323 | $1,830 | 1,067 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $80 | $373 | $2,117 | 1,414 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $80 | $469 | $2,338 | 1,327 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $90 | $274 | $715 | 1,120 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $13 | $55 | $90 | 2,207 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $61 | $155 | $677 | 1,469 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $42 | $85 | $328 | 1,801 |
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 Pennsylvania
Pennsylvania's healthcare costs run approximately 9% above national averages, reflecting the state's concentrated metropolitan markets in Philadelphia and Pittsburgh alongside extensive rural counties requiring specialized access. The state's mature healthcare infrastructure includes major academic medical centers that influence pricing throughout regional markets.
Urban vs. Rural Provider Availability
Pennsylvania's geography creates distinct cost patterns, with abundant gastroenterology specialists in the Philadelphia and Pittsburgh metropolitan areas offering competitive EGD with Biopsy pricing, while rural counties often have limited local options requiring patients to travel to regional centers. This urban-rural divide affects both access and pricing, as rural patients may face higher travel costs but potentially lower facility fees.
Facility Type and Overhead Costs
Pennsylvania's healthcare market includes major health systems like Penn Medicine, UPMC, and Geisinger, which operate hospital-based outpatient endoscopy centers with higher facility fees than independent gastroenterology practices. These health system-owned facilities typically charge more for EGD with Biopsy procedures due to hospital overhead costs and academic medical center pricing structures.
Insurance Market Competition in Pennsylvania
Pennsylvania's insurance market features strong regional competition between Highmark (dominant in western PA) and Independence Blue Cross (dominant in eastern PA), along with national players like UnitedHealthcare throughout the state. This competitive dynamic helps moderate negotiated rates for EGD with Biopsy procedures, though the regional dominance patterns can create pricing variations across different parts of Pennsylvania.
Physician Supply and Demand in Pennsylvania
With 1,592 active providers offering EGD with Biopsy procedures, Pennsylvania maintains adequate gastroenterology capacity relative to its population, particularly in metropolitan areas. This healthy provider supply helps keep pricing competitive and reduces wait times, though rural areas may still experience some access challenges requiring referral to larger regional centers.
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 Pennsylvania
What is the average cost of a EGD with Biopsy visit in Pennsylvania without insurance?
Does Pennsylvania Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Pennsylvania?
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 Pennsylvania?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Pennsylvania?
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 |