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Upper GI Endoscopy with Biopsy: What It Costs and What's Fair

CPT 43239  · Medicare rate: $124  · National avg charge: $2,773  · BillKarma data from 119 providers

Reviewed 2026-10-21  · Pricing data year: 2026

Upper GI Endoscopy with Biopsy (CPT 43239) is a surgical procedure typically performed in a hospital or accredited outpatient surgical center. It is usually recommended after more conservative treatments—such as medication or physical therapy—have not resolved the underlying problem. Recovery time ranges from a few days to several weeks depending on patient health and procedure complexity.

Cost by Billing Grade

Grade Avg Hospital Charge Medicare Rate Est. Patient Cost* Hospitals
C $1,117 $124 $223 12
D $1,494 $124 $299 6
F $2,784 $124 $557 31
N/A $3,162 $124 $632 70

*Estimated patient cost assumes 20% coinsurance after deductible is met. Actual cost depends on your specific plan, deductible status, and network.

Cost Range Across Hospitals

Min: $373 Max: $11,804
Medicare: $124 Avg: $2,773
Grade A (≤2x Medicare) Grade B (2–3x) Grade C (3–5x) Grade D/F (5x+)

What This Procedure Typically Costs by Facility Type

Hospital
119 providers
$373 — $11,804 | Avg: $2,773 (22.4x Medicare)

Find Providers Near You for This Procedure

Showing 10 lowest-markup providers nationally across hospitals, surgery centers, and imaging centers. Enter ZIP code to compare local providers side by side.

Provider Type Location Grade Charge Benchmark Markup
AdventHealth East Orlando Hospital Orlando, FL D $373 $124
Medicare OPPS
 3.0x
Hale Ho'ola Hamakua Hospital Kula, HI N/A $456 $124
Medicare OPPS
 3.7x
Eastern Maine Healthcare Systems Inland Hospital Hospital Waterville, ME N/A $764 $124
Medicare OPPS
 6.2x
ASCENSION PROVIDENCE ROCHESTER HOSPITAL Hospital ROCHESTER, MI F $778 $124
Medicare OPPS
 6.3x
Monroe County Hospital Hospital Monroeville, AL N/A $917 $124
Medicare OPPS
 7.4x
Hilo Medical Center Hospital Hilo, HI N/A $934 $124
Medicare OPPS
 7.6x
ASCENSION SACRED HEART REHABILITATION HOSPITAL Hospital MILWAUKEE, WI F $1,093 $124
Medicare OPPS
 8.8x
ADVENTIST HEALTH SYSTEM/SUNBELT, INC. Hospital TAMPA, FL C $1,117 $124
Medicare OPPS
 9.0x
ADVENTHEALTH DURAND Hospital DURAND, WI C $1,117 $124
Medicare OPPS
 9.0x
ADVENTIST HEALTH SYSTEM-SUNBELT INC Hospital APOPKA, FL D $1,117 $124
Medicare OPPS
 9.0x

What Is a Fair Price for This Procedure?

Medicare pays $124 for Upper GI Endoscopy with Biopsy (CPT 43239). This rate is set by CMS based on the actual cost of delivering the procedure, including physician time, overhead, and equipment. It's the most reliable national benchmark for what the procedure is worth.

A hospital charging $247 (2x Medicare) or less earns an A billing grade — these are the most fairly priced facilities for this procedure. The national average charge is $2,773 (22.4x Medicare).

If your bill shows more than $371 (3x Medicare) for this procedure, it may be worth reviewing the charges carefully. Upload your bill to check →

Frequently Asked Questions

How much does Upper GI Endoscopy with Biopsy cost with insurance?
With insurance, your out-of-pocket cost for Upper GI Endoscopy with Biopsy (CPT 43239) depends on your deductible, coinsurance rate, and in-network status. Medicare pays $124 for this procedure; the national average hospital charge is $2,773. Under standard 20% coinsurance after deductible, a patient at an average-charging hospital would owe approximately $555. Always verify your benefits before scheduling.
Does where I have Upper GI Endoscopy with Biopsy done affect my recovery?
Hospital quality and surgical volume can influence outcomes for procedures like Upper GI Endoscopy with Biopsy. High-volume centers tend to have lower complication rates for complex surgeries. However, billing grade is separate from quality ratings—some highly graded billing hospitals also have strong clinical outcomes. Review both the BillKarma billing grade and CMS quality stars when choosing a facility.
How do I negotiate the cost of Upper GI Endoscopy with Biopsy if I'm on a high-deductible plan?
If you're paying a significant portion out-of-pocket, ask the hospital for their cash price before scheduling. Many hospitals offer 10–40% discounts for self-pay patients. Medicare pays $124 for this procedure—use that as your negotiating anchor. Also ask the billing department about payment plans or charity care if the cost poses a financial hardship.

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