Upper Endoscopy (EGD) price: Medicare anchor and facility lever
Prices only. No diagnosis or treatment advice. Use the CPT code and Medicare anchor below to ask for an all-in cash price, then confirm your price in writing before service.
Before you book: confirm your price in writing before service. Ask for the exact CPT code, the setting, and whether professional, facility, anesthesia, and pathology are included.
CPT code
43235
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
CPT 43235 is diagnostic EGD. With biopsy is 43239. Confirm the expected code before comparing quotes, because a biopsy changes both the procedure code and the pathology bill.
Verified Medicare anchor
Nonfacility PFS: $279.91
Facility professional PFS: $123.95
Facility fee bills separately in hospital or ASC settings.
Source: CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01 - CY2025. Verified 2026-10-04. Medicare anchor only, not a self-pay price.
What this procedure is, in price terms
Upper Endoscopy (EGD) is billed under CPT 43235: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) The code, not the marketing name, determines the Medicare anchor and the cash quote. If the order changes - for example with contrast instead of without, or a biopsy is added - the code changes and the price changes with it. Ask the ordering clinician's office to confirm the expected code before you price-shop, and ask the facility what code will be billed if the plan changes on the day.
What the price includes
- Endoscopist professional fee for the diagnostic procedure (PFS anchor below)
- Use of the endoscopy suite and standard recovery monitoring in the facility payment
What the price usually excludes
- Anesthesia or sedation billed separately
- Pathology when a biopsy is taken (for example 88305)
- The pre-procedure visit and follow-up visit when billed separately
A quote is complete only when it states which of the excluded items apply to you and what each costs. Get that in writing.
Why prices vary for CPT 43235
Like colonoscopy, EGD pricing splits into professional, facility, anesthesia, and pathology layers. The PFS professional anchor is lower in a facility setting than in an office because the facility payment carries the overhead. Hospital OPPS facility payment is higher than the ASC facility payment for the same endoscopy family, which is the main lever a patient can shop on when the clinician practices in more than one setting.
Geography also matters. Physician Fee Schedule amounts are locality-adjusted, so the Michigan Locality 01 anchor on this page will differ somewhat from the amount in another locality. OPPS amounts are national unadjusted rates before the hospital wage index is applied. Use the anchor for order of magnitude and for the facility comparison, not as a prediction of your bill.
Unique insight for CPT 43235
For this code the nonfacility anchor is $279.91 and the facility professional anchor is $123.95. The difference between those two verified amounts is the overhead that moves to a separate facility bill in a hospital or ASC. A quote that only names the lower professional figure is missing that layer.
Locality caveat: PFS amounts on this page are Michigan Locality 01 anchors. Your locality will differ. Confirm your price in writing before service.
The facility-type lever
Ask for the setting (hospital vs ASC vs office), the anesthesia plan, and whether a biopsy is expected. Price each layer separately, then add them.
Compare the same CPT code in more than one setting when your clinician allows a choice:
- Hospital Outpatient Department - OPPS (APC-based facility payment) + Physician Fee Schedule professional fee. Facility fee: Yes - separate OPPS facility payment to the hospital.
- Ambulatory Surgery Center - ASC payment system (procedure-based, generally below OPPS) + Physician Fee Schedule professional fee. Facility fee: Yes - ASC facility fee, typically lower than hospital OPPS for the same procedure.
- Independent Imaging Center - Physician Fee Schedule global payment when the center owns the equipment and employs or contracts the radiologist. Facility fee: No separate hospital facility fee - the technical component is inside the global PFS payment.
- Physician Office - Physician Fee Schedule nonfacility payment (higher practice-expense component than facility rate). Facility fee: No separate facility fee - office overhead is inside the nonfacility PFS rate.
Use the Price Anchor Explorer to see how the anchor presentation changes by facility type.
Self-pay ranges on this page
Self-pay ranges are not published yet for Upper Endoscopy (EGD). MyCarePrice adds a self-pay range only where it can be verified from a public source under Procedure Price Method v1.0. Until then, this page ships the verified Medicare anchor plus facility-type education. That is deliberate: an invented range would be worse than no range.
To get a real self-pay number today, ask the facility directly: "What is the all-in cash price for CPT 43235, including professional, facility, anesthesia, and pathology if they apply?" See How to ask for the cash price and Questions to ask billing before your procedure.
Questions to ask before you book
- What CPT code will be billed if nothing changes, and what code will be billed if the plan changes?
- Is the quote global, or will the professional fee bill separately?
- What setting is this price for, and what would the same code cost in the other setting you offer?
- Are anesthesia and pathology included, likely, or billed separately?
- Can I have the all-in price in writing, with the code, setting, and inclusions listed?
Frequently asked questions
What is the Medicare anchor for Upper Endoscopy (EGD)?
The verified Physician Fee Schedule anchors for CPT 43235 are nonfacility $279.91 and facility professional $123.95 (CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01, CY2025, verified 2026-10-04). The facility fee bills separately in a hospital or ASC. This is a Medicare anchor, not your self-pay price. Confirm your price in writing before service.
Why does the same procedure cost more at a hospital?
Medicare pays the facility portion differently by setting. A hospital outpatient department bills OPPS plus the professional fee. An imaging center or office usually bills one global PFS amount. Same CPT code, different payment system. Ask for the all-in cash price in each setting using the same CPT code.
Does this page tell me whether I should get this procedure?
No. MyCarePrice publishes prices only. We do not provide diagnosis, treatment, or should-you-get-this-test advice. Decisions about care belong with you and your clinician.
Why is no self-pay range published for Upper Endoscopy (EGD)?
A self-pay range appears only where it can be verified from a public source under Procedure Price Method v1.0. For CPT 43235 that verification is not published yet, so this page ships the verified Medicare anchor plus facility-type education instead of an invented range. Ask the facility for the all-in cash price and confirm it in writing before service.
Sources and verification
- Physician Fee Schedule anchor: CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01, CY2025, verified 2026-10-04. Michigan Locality 01 - your locality amount will differ.
- Method: Procedure Price Method v1.0. Medicare rates are shown as a separate anchor, never blended into a self-pay range. Self-pay ranges are published only where verified from a public source.
- Also see How Prices Work for the two payment systems behind these anchors.
This page is price information only. It is not medical advice and does not recommend for or against any procedure. Confirm your price in writing before service.