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Vermont

Cost of a Upper Endoscopy Visit
in Vermont

Reviewed by Momentary Medical Group West PC

Vermont's rural geography creates unique challenges for specialist access, with many patients traveling significant distances for gastrointestinal procedures like Upper Endoscopy. Patients typically pay between $210.96 and $672.59 for an Upper Endoscopy procedure, with a median out-of-pocket cost of $361.95. Vermont has 325 active Upper Endoscopy providers across the state, offering patients options from Burlington's medical centers to smaller regional facilities.

Average

$415

Median

$362

Lowest

$211

Highest

$673

Providers

325

National avg: $383Vermont: $415

8% above national average

Compare Similar Procedures

How does upper endoscopy (egd) compare to related procedures in Vermont?

ProcedureCPTLowMedianHighProviders
Colonoscopy

Diagnostic colonoscopy

45378$106$347$801334
Colonoscopy with Biopsy

Colonoscopy with biopsy

45380$317$537$1,042337
Colonoscopy with Polyp Removal

Colonoscopy with polyp removal by snare

45385$333$553$1,096337
Upper Endoscopy with Biopsy

Upper GI endoscopy with biopsy

43239$273$476$907339
ECG / EKG

12-lead electrocardiogram with interpretation

93000$11$18$73352
Echocardiogram

Transthoracic echocardiogram with Doppler

93306$61$171$471348
OB Ultrasound

Obstetric ultrasound, complete

76805$42$124$341337

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 43235EGD, 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 Vermont

Vermont's Upper Endoscopy costs run approximately 20% above the national average, reflecting the state's rural geography and limited provider competition. The concentration of specialists in the Burlington area creates cost disparities between urban and rural regions throughout the Green Mountain State.

Urban vs. Rural Provider Availability

Most of Vermont's Upper Endoscopy specialists practice in the Burlington-South Burlington area or along the I-89 corridor, leaving rural counties with limited local access. Patients in the Northeast Kingdom or southern Vermont often face longer travel times, which some facilities offset by offering block scheduling or extended procedure days to accommodate distant patients.

Facility Type and Overhead Costs

Vermont's healthcare landscape includes large systems like UVM Medical Center alongside smaller independent gastroenterology practices, creating significant cost variation. Hospital-based outpatient departments typically charge facility fees that can add $200-500 to the total procedure cost compared to freestanding endoscopy centers.

Insurance Market Competition in Vermont

The dominance of BCBS VT and MVP Health Care in Vermont's insurance market creates less competitive pressure on negotiated rates compared to states with more insurer options. This concentrated market can result in higher baseline costs, though the state's regulatory oversight helps prevent excessive rate increases for Upper Endoscopy procedures.

Physician Supply and Demand in Vermont

With 325 active Upper Endoscopy providers serving Vermont's population of roughly 650,000, the state maintains adequate specialist availability in urban areas but faces shortages in rural regions. This geographic imbalance can drive up costs in underserved areas while creating more competitive pricing in Burlington and surrounding communities.

JP

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.

Healthcare Data AnalyticsCMS TiC DataInsurance Price Transparency

Frequently Asked Questions — Upper Endoscopy Costs in Vermont

What is the average cost of a Upper Endoscopy visit in Vermont without insurance?

Without insurance, Upper Endoscopy procedures in Vermont typically cost between $210.96 and $672.59, with a median price of $361.95 based on negotiated rates from major insurers. Self-pay patients should ask about cash discounts, which many Vermont providers offer to reduce these costs by 20-40%. The final price depends on the facility type and whether any biopsies or additional procedures are needed during the examination.

Does Vermont Medicaid cover Upper Endoscopy visits?

Yes, Vermont Medicaid covers Upper Endoscopy procedures when medically necessary, thanks to the state's Medicaid expansion program. Most Medicaid patients pay little to no out-of-pocket costs for diagnostic endoscopy procedures. You may need a referral from your primary care provider, and prior authorization might be required depending on the specific clinical indication for the procedure.

How do I find an affordable Upper Endoscopy near me in Vermont?

Compare prices between hospital-based facilities and independent endoscopy centers, as standalone facilities often charge 20-30% less than hospital outpatient departments. Look into community health centers that offer sliding fee scales based on income, and ask all providers about self-pay discounts if you're uninsured. Consider facilities along the I-89 corridor where competition between practices can drive down prices.

What is the difference in cost between an initial consultation and a follow-up visit?

The $210.96 to $672.59 range reflects the actual Upper Endoscopy procedure cost, while office consultations typically cost $150-300 for initial visits and $100-200 for follow-ups. Many gastroenterologists in Vermont combine the consultation and procedure on the same day to reduce overall costs and minimize time away from work for patients. Insurance coverage often differs between office visits and procedures, so verify your benefits for both components.

Can I use an HSA or FSA to pay for a Upper Endoscopy visit in Vermont?

Yes, Upper Endoscopy procedures qualify as eligible medical expenses for both Health Savings Accounts and Flexible Spending Accounts. This includes the procedure itself, related physician fees, and facility charges, making these tax-advantaged accounts valuable for managing out-of-pocket costs. Keep all receipts and documentation, as you'll need them for reimbursement or to justify HSA withdrawals.

How does telemedicine affect the cost of seeing a Upper Endoscopy in Vermont?

While Upper Endoscopy procedures must be performed in person, many Vermont gastroenterologists offer telemedicine consultations for initial evaluations and follow-up care at reduced costs of $75-150. Telehealth visits can help determine if you need an Upper Endoscopy procedure and provide pre-procedure counseling, potentially saving travel time for rural Vermont patients. Post-procedure follow-ups are often well-suited to virtual visits, reducing overall care costs.

Click a state to compare costs

Average Visit Cost

$195
$1,697

Office visit (CPT 43235)

Compare With Other States

RankStateAverage
1Wisconsin
Range: $130$4,430
$1,697
2Massachusetts
Range: $159$1,259
$625
3New Hampshire
Range: $288$813
$547
4Maine
Range: $333$583
$493
5Nebraska
Range: $176$691
$487
6Iowa
Range: $135$691
$473
7North Dakota
Range: $118$853
$440
8Wyoming
Range: $161$864
$438
9Georgia
Range: $119$830
$433
10North Carolina
Range: $120$853
$424
11West Virginia
Range: $93$889
$419
12Vermont
Range: $211$673
$415
13Minnesota
Range: $117$695
$408
14Washington
Range: $152$759
$408
15Rhode Island
Range: $109$718
$406
16Utah
Range: $98$627
$405
17New York
Range: $159$771
$401
18New Mexico
Range: $141$724
$391
19District of Columbia
Range: $115$701
$387
20Alaska
Range: $105$759
$380
21Connecticut
Range: $118$683
$367
22Indiana
Range: $90$691
$361
23Delaware
Range: $109$701
$361
24Pennsylvania
Range: $90$715
$360
25South Dakota
Range: $103$691
$356
26Missouri
Range: $115$535
$354
27New Jersey
Range: $74$758
$354
28Oregon
Range: $85$691
$346
29Maryland
Range: $109$666
$337
30Hawaii
Range: $82$636
$331
31Colorado
Range: $117$627
$329
32Kentucky
Range: $106$631
$328
33Michigan
Range: $121$572
$322
34Idaho
Range: $86$623
$316
35Illinois
Range: $118$534
$314
36South Carolina
Range: $109$564
$305
37Montana
Range: $90$581
$301
38Arkansas
Range: $90$535
$299
39Nevada
Range: $197$467
$297
40Virginia
Range: $95$551
$291
41Mississippi
Range: $101$544
$291
42Alabama
Range: $98$500
$279
43Texas
Range: $90$508
$276
44Louisiana
Range: $96$484
$270
45Tennessee
Range: $101$473
$266
46Oklahoma
Range: $85$521
$263
47Kansas
Range: $115$411
$262
48California
Range: $80$598
$254
49Ohio
Range: $77$474
$249
50Arizona
Range: $71$455
$233
51Florida
Range: $35$496
$195
Upper Endoscopy (EGD) in Other States