Cost of a Upper Endoscopy Visit
in Massachusetts
Reviewed by Momentary Medical Group West PC
Massachusetts leads the nation in healthcare quality rankings while maintaining one of the most regulated insurance markets in the country. Upper Endoscopy patients typically pay between $159 and $1,259, with a median negotiated rate of $457 based on insurer contracts with over 1,000 active providers statewide. Browse all Upper Endoscopy specialists practicing across Massachusetts to find the right provider for your needs.
Average
$625
Median
$457
Lowest
$159
Highest
$1,259
Providers
1,065
63% above national average
Compare Similar Procedures
How does upper endoscopy (egd) 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 with Biopsy Upper GI endoscopy with biopsy | 43239 | $80 | $508 | $1,654 | 1,412 |
| 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 43235 — EGD, diagnostic). 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 43235 covers
Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 43235 (EGD, diagnostic), as mandated by the CMS Price Transparency Rule.
What CPT 43235 covers: the provider's professional fee for upper endoscopy (egd). 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 Upper Endoscopy Visit Costs Vary Across Massachusetts
Massachusetts Upper Endoscopy costs run approximately 20% above national averages, reflecting the state's concentration of prestigious academic medical centers and higher overall cost of living. The Commonwealth's physician-dense market paradoxically maintains high prices due to strong provider consolidation and limited insurer competition outside the dominant three health plans.
Urban vs. Rural Provider Availability
Greater Boston and surrounding suburbs host the majority of Massachusetts gastroenterologists, creating significant access advantages but higher costs compared to rural Western Massachusetts and Cape Cod regions. Patients in Springfield, Worcester, and other secondary cities often travel to Boston for specialized Upper Endoscopy procedures, adding transportation costs. Rural residents may face longer wait times but potentially lower facility fees at community hospitals.
Facility Type and Overhead Costs
Hospital-based Upper Endoscopy centers affiliated with Partners HealthCare (now Mass General Brigham), Beth Israel Lahey Health, and other major health systems typically charge premium rates due to higher overhead costs. Independent gastroenterology practices and ambulatory surgery centers throughout Massachusetts often provide the same procedures at 30-50% lower total costs. Academic medical centers command the highest prices but offer access to cutting-edge treatments and clinical trials.
Insurance Market Competition in Massachusetts
The state's insurance market concentration among Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and Harvard Pilgrim limits competitive pressure on provider reimbursement rates. These three insurers control roughly 80% of the commercial market, allowing gastroenterologists to maintain higher negotiated rates compared to more competitive state markets. Limited insurer options also reduce patients' ability to shop for lower-cost coverage alternatives.
Physician Supply and Demand in Massachusetts
With over 1,000 Upper Endoscopy providers statewide, Massachusetts maintains above-average physician density relative to its population of 7 million residents. Despite this apparent abundance, demand remains high due to the state's aging population and health-conscious culture that emphasizes preventive screening. The concentration of specialists in Boston creates geographic access barriers that can drive up costs for patients seeking convenient care locations.
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 — Upper Endoscopy Costs in Massachusetts
What is the average cost of a Upper Endoscopy visit in Massachusetts without insurance?
Does Massachusetts Medicaid cover Upper Endoscopy visits?
How do I find an affordable Upper Endoscopy 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 Upper Endoscopy visit in Massachusetts?
How does telemedicine affect the cost of seeing a Upper Endoscopy in Massachusetts?
Click a state to compare costs
Average Visit Cost
Office visit (CPT 43235)
Compare With Other States
| Rank | State | Average↓ |
|---|---|---|
| 1 | Wisconsin Range: $130 – $4,430 | $1,697 |
| 2 | Massachusetts Range: $159 – $1,259 | $625 |
| 3 | New Hampshire Range: $288 – $813 | $547 |
| 4 | Maine Range: $333 – $583 | $493 |
| 5 | Nebraska Range: $176 – $691 | $487 |
| 6 | Iowa Range: $135 – $691 | $473 |
| 7 | North Dakota Range: $118 – $853 | $440 |
| 8 | Wyoming Range: $161 – $864 | $438 |
| 9 | Georgia Range: $119 – $830 | $433 |
| 10 | North Carolina Range: $120 – $853 | $424 |
| 11 | West Virginia Range: $93 – $889 | $419 |
| 12 | Vermont Range: $211 – $673 | $415 |
| 13 | Minnesota Range: $117 – $695 | $408 |
| 14 | Washington Range: $152 – $759 | $408 |
| 15 | Rhode Island Range: $109 – $718 | $406 |
| 16 | Utah Range: $98 – $627 | $405 |
| 17 | New York Range: $159 – $771 | $401 |
| 18 | New Mexico Range: $141 – $724 | $391 |
| 19 | District of Columbia Range: $115 – $701 | $387 |
| 20 | Alaska Range: $105 – $759 | $380 |
| 21 | Connecticut Range: $118 – $683 | $367 |
| 22 | Indiana Range: $90 – $691 | $361 |
| 23 | Delaware Range: $109 – $701 | $361 |
| 24 | Pennsylvania Range: $90 – $715 | $360 |
| 25 | South Dakota Range: $103 – $691 | $356 |
| 26 | Missouri Range: $115 – $535 | $354 |
| 27 | New Jersey Range: $74 – $758 | $354 |
| 28 | Oregon Range: $85 – $691 | $346 |
| 29 | Maryland Range: $109 – $666 | $337 |
| 30 | Hawaii Range: $82 – $636 | $331 |
| 31 | Colorado Range: $117 – $627 | $329 |
| 32 | Kentucky Range: $106 – $631 | $328 |
| 33 | Michigan Range: $121 – $572 | $322 |
| 34 | Idaho Range: $86 – $623 | $316 |
| 35 | Illinois Range: $118 – $534 | $314 |
| 36 | South Carolina Range: $109 – $564 | $305 |
| 37 | Montana Range: $90 – $581 | $301 |
| 38 | Arkansas Range: $90 – $535 | $299 |
| 39 | Nevada Range: $197 – $467 | $297 |
| 40 | Virginia Range: $95 – $551 | $291 |
| 41 | Mississippi Range: $101 – $544 | $291 |
| 42 | Alabama Range: $98 – $500 | $279 |
| 43 | Texas Range: $90 – $508 | $276 |
| 44 | Louisiana Range: $96 – $484 | $270 |
| 45 | Tennessee Range: $101 – $473 | $266 |
| 46 | Oklahoma Range: $85 – $521 | $263 |
| 47 | Kansas Range: $115 – $411 | $262 |
| 48 | California Range: $80 – $598 | $254 |
| 49 | Ohio Range: $77 – $474 | $249 |
| 50 | Arizona Range: $71 – $455 | $233 |
| 51 | Florida Range: $35 – $496 | $195 |