Cost of a Upper Endoscopy Visit
in Virginia
Reviewed by Momentary Medical Group West PC
Virginia's healthcare landscape benefits from Medicaid expansion and a competitive insurance market anchored by Anthem, Optima Health, and UHC, creating diverse pricing options for Upper Endoscopy procedures. Patients typically pay between $95 and $551 for an Upper Endoscopy, with a median negotiated rate of $228 based on transparency data from over 2,700 active providers across the Commonwealth. Virginia's established gastroenterology network spans from Northern Virginia's medical corridors to rural communities, allowing patients to browse providers statewide for cost-effective care options.
Average
$291
Median
$228
Lowest
$95
Highest
$551
Providers
2,703
24% below national average
Compare Similar Procedures
How does upper endoscopy (egd) 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 with Biopsy Upper GI endoscopy with biopsy | 43239 | $90 | $257 | $728 | 2,890 |
| 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 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 Virginia
Virginia's Upper Endoscopy costs run approximately 25% below the national average, reflecting the state's competitive provider market and efficient care delivery systems. The Commonwealth's geographic diversity creates distinct cost zones from expensive Northern Virginia suburbs to affordable rural Appalachian communities.
Urban vs. Rural Provider Availability
Northern Virginia's proximity to Washington D.C. creates premium pricing for Upper Endoscopy procedures, while rural counties in Southwest Virginia and the Eastern Shore face provider shortages that can drive up costs. The Richmond and Norfolk metro areas offer balanced provider competition with moderate pricing compared to both extremes.
Facility Type and Overhead Costs
Hospital-based outpatient endoscopy centers in Virginia typically charge 30-50% more than independent ambulatory surgery centers due to higher facility fees and overhead costs. Major health systems like VCU Health, Sentara, and Inova operate extensive networks, while independent gastroenterology groups often provide more competitive cash-pay rates.
Insurance Market Competition in Virginia
Strong competition between Anthem, Optima Health, and UHC in Virginia's individual and employer markets has kept negotiated rates relatively stable for Upper Endoscopy procedures. Optima Health's regional focus and Anthem's statewide presence create geographic variations in network adequacy and pricing structures across different Virginia markets.
Physician Supply and Demand in Virginia
With over 2,700 providers performing Upper Endoscopy procedures statewide, Virginia maintains adequate specialist availability in urban areas while facing shortages in rural regions. This supply distribution creates longer wait times and higher costs in underserved counties, while competitive markets in Richmond, Norfolk, and Northern Virginia offer more scheduling flexibility and price options.
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 Virginia
What is the average cost of an Upper Endoscopy visit in Virginia without insurance?
Does Virginia Medicaid cover Upper Endoscopy visits?
How do I find an affordable Upper Endoscopy 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 an Upper Endoscopy visit in Virginia?
How does telemedicine affect the cost of seeing an Upper Endoscopy in Virginia?
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 |