Cost of a Upper Endoscopy Visit
in New York
Reviewed by Momentary Medical Group West PC
New York's healthcare market operates at costs roughly 22% above the national average, driven by the state's concentrated urban medical centers and extensive provider networks. Patients seeking Upper Endoscopy services typically pay between $159 and $771, with a median out-of-pocket cost of $274 based on negotiated insurance rates. The state maintains over 30,000 active Upper Endoscopy providers across its diverse geographic regions, allowing patients to browse extensive options throughout New York's metropolitan and rural areas.
Average
$401
Median
$274
Lowest
$159
Highest
$771
Providers
30,910
5% above national average
Compare Similar Procedures
How does upper endoscopy (egd) compare to related procedures in New York?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $101 | $298 | $1,830 | 30,995 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $241 | $488 | $2,117 | 31,059 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $276 | $507 | $2,338 | 30,991 |
| Upper Endoscopy with Biopsy Upper GI endoscopy with biopsy | 43239 | $166 | $417 | $1,647 | 31,089 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $10 | $16 | $63 | 32,178 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $51 | $171 | $895 | 31,068 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $36 | $112 | $328 | 31,848 |
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 New York
New York's healthcare costs run approximately 22% above national averages, reflecting the state's high concentration of academic medical centers, elevated real estate costs, and complex regulatory environment. The dramatic cost differential between New York City's premium medical facilities and rural upstate providers creates some of the nation's widest intrastate pricing variations for specialty care.
Urban vs. Rural Provider Availability
New York City and Long Island maintain dense concentrations of gastroenterologists, while rural counties in the North Country and Southern Tier face significant specialist shortages requiring patient travel to larger cities. The Adirondack and Finger Lakes regions rely heavily on telemedicine consultations and visiting specialist clinics to serve their populations. Urban areas benefit from competitive pricing pressure, while rural markets often see limited provider choice driving up consultation fees.
Facility Type and Overhead Costs
Hospital-owned gastroenterology practices dominate New York's major metropolitan areas, with health systems like NewYork-Presbyterian, Northwell Health, and Rochester Regional Health acquiring independent physician groups. These larger systems can command premium rates due to their comprehensive service offerings and negotiating power with insurers. Independent gastroenterology practices, more common in mid-sized cities like Syracuse and Albany, often provide more competitive pricing for routine Upper Endoscopy consultations.
Insurance Market Competition in New York
Empire BlueCross BlueShield holds significant market share across New York, with UnitedHealthcare, Aetna, and Cigna providing competitive alternatives primarily in urban markets. The state's insurance marketplace offers robust competition in metropolitan areas but limited insurer participation in rural counties, affecting negotiated rates with gastroenterology providers. New York's strict insurance regulations and community rating requirements help standardize pricing within geographic regions but may contribute to overall higher premium costs.
Physician Supply and Demand in New York
With over 30,000 active Upper Endoscopy providers statewide, New York maintains strong specialist availability in urban centers while facing access challenges in rural communities. The abundance of gastroenterologists in New York City creates competitive pricing pressure, while underserved upstate regions may see longer wait times and higher consultation fees. Medical school graduates from prestigious New York institutions often establish practices locally, contributing to the state's robust but geographically uneven specialist workforce.
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 New York
What is the average cost of a Upper Endoscopy visit in New York without insurance?
Does New York Medicaid cover Upper Endoscopy visits?
How do I find an affordable Upper Endoscopy near me in New York?
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 New York?
How does telemedicine affect the cost of seeing a Upper Endoscopy in New York?
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 |