Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Medicare pricing data for 26,532 providers across 52 states
This procedure has a 8.6x markup — hospitals charge $1,376 but Medicare allows only $159.83. Uninsured patients may face bills 8.6 times higher than what insurance negotiates. Prices vary significantly by location — from $107 in Wisconsin to $287 in Puerto Rico. Where you get this procedure matters more than almost any other factor. This is one of the most commonly performed procedures in Medicare, with 1.6 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS code 43239) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $159.83, but hospitals typically charge $1,376 — a 8.6x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $159.83, your out-of-pocket cost would be approximately $31.97. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 8.6x more than what Medicare allows for this procedure. Medicare actually pays $125.39 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Puerto Rico | $287 | $349 | 197 | 1,502 | +79.3% |
| New York | $225 | $1,809 | 2,150 | 105,933 | +40.6% |
| Alaska | $210 | $2,369 | 79 | 3,946 | +31.7% |
| New Jersey | $207 | $2,175 | 779 | 69,839 | +29.4% |
| California | $193 | $1,754 | 2,345 | 173,704 | +20.6% |
| Nevada | $185 | $2,300 | 138 | 14,140 | +16.0% |
| Maryland | $178 | $1,036 | 497 | 48,531 | +11.2% |
| Delaware | $171 | $1,108 | 97 | 8,328 | +6.9% |
| Arizona | $170 | $1,296 | 495 | 37,277 | +6.3% |
| Rhode Island | $167 | $1,307 | 91 | 6,061 | +4.4% |
| Hawaii | $161 | $1,437 | 89 | 3,733 | +0.8% |
| Florida | $159 | $1,375 | 1,734 | 170,206 | -0.3% |
| Pennsylvania | $159 | $975 | 1,293 | 69,765 | -0.7% |
| Connecticut | $157 | $1,285 | 352 | 17,764 | -1.6% |
| Colorado | $156 | $2,071 | 415 | 21,131 | -2.5% |
| Georgia | $156 | $1,149 | 732 | 48,141 | -2.5% |
| North Carolina | $154 | $1,033 | 863 | 52,209 | -3.9% |
| Oregon | $154 | $1,292 | 356 | 12,597 | -3.9% |
| Washington | $151 | $887 | 559 | 29,660 | -5.4% |
| South Carolina | $149 | $1,007 | 391 | 37,600 | -6.9% |
| Wyoming | $148 | $1,661 | 54 | 5,125 | -7.4% |
| Massachusetts | $148 | $1,155 | 732 | 34,987 | -7.7% |
| Texas | $146 | $1,838 | 1,866 | 120,039 | -8.6% |
| Louisiana | $146 | $954 | 359 | 26,880 | -8.8% |
| Ohio | $145 | $938 | 1,146 | 53,522 | -9.2% |
| Arkansas | $145 | $827 | 239 | 18,719 | -9.5% |
| New Mexico | $143 | $1,005 | 116 | 7,118 | -10.7% |
| Michigan | $143 | $775 | 905 | 38,966 | -10.8% |
| Mississippi | $141 | $1,201 | 181 | 20,747 | -11.9% |
| Tennessee | $140 | $1,120 | 517 | 35,321 | -12.5% |
| Iowa | $140 | $1,286 | 265 | 12,289 | -12.7% |
| Nebraska | $139 | $1,084 | 191 | 9,731 | -12.9% |
| Virginia | $139 | $1,121 | 671 | 34,293 | -12.9% |
| Minnesota | $139 | $1,004 | 535 | 15,708 | -13.2% |
| Illinois | $136 | $1,362 | 1,040 | 62,012 | -15.0% |
| Kansas | $134 | $1,246 | 261 | 15,451 | -16.1% |
| Utah | $132 | $1,778 | 188 | 9,759 | -17.7% |
| Indiana | $129 | $1,388 | 521 | 29,317 | -19.1% |
| Idaho | $126 | $637 | 143 | 7,858 | -20.9% |
| Alabama | $126 | $1,028 | 363 | 23,547 | -21.4% |
| Vermont | $124 | $1,150 | 38 | 1,757 | -22.6% |
| New Hampshire | $123 | $1,851 | 136 | 7,527 | -23.0% |
| Missouri | $123 | $1,173 | 543 | 27,750 | -23.2% |
| Oklahoma | $121 | $761 | 268 | 17,560 | -24.6% |
| District of Columbia | $119 | $952 | 92 | 3,126 | -25.6% |
| Montana | $117 | $787 | 80 | 3,829 | -26.8% |
| South Dakota | $115 | $987 | 101 | 5,536 | -28.2% |
| Kentucky | $113 | $942 | 421 | 23,321 | -29.5% |
| West Virginia | $111 | $676 | 165 | 5,913 | -30.6% |
| Maine | $109 | $647 | 106 | 3,904 | -31.5% |
| North Dakota | $109 | $970 | 72 | 2,802 | -31.9% |
| Wisconsin | $107 | $2,154 | 533 | 18,952 | -33.2% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
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