Cost of a EGD with Biopsy Visit
in Virginia
Reviewed by Momentary Medical Group West PC
Virginia's healthcare system serves over 8.6 million residents through a network spanning from the densely populated Northern Virginia corridor to rural Appalachian communities, creating significant cost variations for specialized procedures. Patients seeking an EGD with Biopsy in Virginia typically pay between $90 and $728, with a median out-of-pocket cost of $257. Virginia maintains approximately 2,890 active providers offering this procedure across the state, giving patients considerable choice when selecting care.
Average
$358
Median
$257
Lowest
$90
Highest
$728
Providers
2,890
33% below national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Virginia?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $124 | $297 | $682 | 2,843 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $98 | $343 | $830 | 3,248 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $98 | $398 | $916 | 3,147 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $95 | $228 | $551 | 2,703 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $13 | $22 | $98 | 3,469 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $59 | $150 | $390 | 3,292 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $36 | $85 | $215 | 2,860 |
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 Virginia
Virginia's healthcare costs run approximately 3% above the national average, driven by the expensive Northern Virginia market's proximity to Washington D.C. and a growing ambulatory surgery center market that's increasing competitive pressure on traditional hospital-based services. The state's diverse geography creates distinct cost regions from high-priced urban corridors to more affordable rural areas.
Urban vs. Rural Provider Availability
Virginia's population concentrates heavily in the Northern Virginia, Richmond, and Hampton Roads metropolitan areas, where specialist density keeps wait times shorter but costs higher. Rural counties in southwestern Virginia and the Shenandoah Valley have fewer gastroenterologists, often requiring patients to travel significant distances but potentially finding lower procedure costs.
Facility Type and Overhead Costs
Virginia's healthcare system includes major academic centers like VCU Health and UVA Health, regional hospital systems such as Sentara and Inova, and a growing network of independent ambulatory surgery centers. Hospital-based outpatient departments typically charge facility fees that can double the total cost compared to freestanding endoscopy centers.
Insurance Market Competition in Virginia
The presence of multiple major insurers including Anthem, Optima Health, and UHC creates moderate competition that helps control negotiated rates compared to states dominated by a single payer. Virginia's large federal employee population through Anthem's Federal Employee Program also influences regional pricing structures and network adequacy requirements.
Physician Supply and Demand in Virginia
With approximately 2,890 providers offering EGD with Biopsy procedures across Virginia, the state maintains reasonable access relative to its population, though distribution favors urban areas. This adequate supply helps prevent the dramatic price premiums seen in physician shortage areas, while competition among providers creates opportunities for cost-conscious patients to shop around.
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 Virginia
What is the average cost of a EGD with Biopsy visit in Virginia without insurance?
Does Virginia Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Virginia?
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 Virginia?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Virginia?
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 |