Cost of a Upper Endoscopy Visit
in Pennsylvania
Reviewed by Momentary Medical Group West PC
Pennsylvania's healthcare market, dominated by major systems like UPMC and Penn Medicine across its urban corridors, offers extensive Upper Endoscopy services through over 1,100 active providers statewide. Patients typically pay between $90 and $715 for an Upper Endoscopy procedure, with a median negotiated rate of $274 based on current insurance contracts. Pennsylvania residents can browse providers across all regions, from Philadelphia's dense medical district to rural counties where specialized gastroenterology services may require longer travel distances.
Average
$360
Median
$274
Lowest
$90
Highest
$715
Providers
1,120
6% below national average
Compare Similar Procedures
How does upper endoscopy (egd) 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 with Biopsy Upper GI endoscopy with biopsy | 43239 | $80 | $273 | $1,647 | 1,592 |
| 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 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 Pennsylvania
Pennsylvania's Upper Endoscopy costs run approximately 9% below national averages, reflecting the state's competitive healthcare market concentrated in Philadelphia and Pittsburgh metropolitan areas. The state's mix of large academic medical centers, regional health systems, and independent gastroenterology practices creates varied pricing structures across different geographic regions.
Urban vs. Rural Provider Availability
Pennsylvania's concentrated urban medical markets in Philadelphia, Pittsburgh, and Harrisburg offer abundant Upper Endoscopy options with competitive pricing, while rural counties may have limited gastroenterology specialists requiring patient travel. The state's mountainous central regions and northern counties often rely on visiting specialists or require referrals to urban centers for endoscopic procedures. This geographic disparity can affect both access and pricing, with rural patients sometimes facing higher travel costs but potentially lower procedure fees.
Facility Type and Overhead Costs
Hospital-based outpatient endoscopy departments at major Pennsylvania systems like UPMC, Penn Medicine, and Geisinger typically charge higher facility fees than independent ambulatory surgery centers. Many gastroenterology practices in Pennsylvania operate their own endoscopy suites, offering potentially lower total costs by eliminating separate facility fees. Academic medical centers in Philadelphia and Pittsburgh may have higher overhead costs but also offer complex therapeutic procedures not available at community facilities.
Insurance Market Competition in Pennsylvania
Pennsylvania's insurance landscape includes major regional players like Highmark and Independence Blue Cross alongside national insurers like UnitedHealthcare, creating competitive negotiated rate structures. The state's divided insurance territories, with Highmark dominant in western regions and Independence Blue Cross serving southeastern areas, can create pricing variations across counties. This competitive environment generally benefits consumers through varied network options and competitive pricing for Upper Endoscopy procedures.
Physician Supply and Demand in Pennsylvania
With over 1,100 active Upper Endoscopy providers, Pennsylvania maintains a robust supply of gastroenterologists relative to its population, particularly concentrated in urban areas. This adequate physician supply helps maintain competitive pricing and reasonable scheduling availability in major metropolitan areas. However, rural counties may still experience specialist shortages, potentially leading to longer wait times but not necessarily higher procedure costs due to the state's overall competitive market dynamics.
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 Pennsylvania
What is the average cost of a Upper Endoscopy visit in Pennsylvania without insurance?
Does Pennsylvania Medicaid cover Upper Endoscopy visits?
How do I find an affordable Upper Endoscopy 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 Upper Endoscopy visit in Pennsylvania?
How does telemedicine affect the cost of seeing a Upper Endoscopy in Pennsylvania?
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 |