Endoscopy Cost: Prices With & Without Insurance

An upper endoscopy, also called an EGD or upper GI endoscopy, uses a thin flexible tube with a camera to look at the esophagus, stomach and the start of the small intestine. This page covers upper endoscopy pricing. Colonoscopy is a different procedure with its own pricing, so figures here should not be used to estimate it.

The sticker price of an endoscopy is rarely one number. The doctor, the facility, the anesthesia and any lab work on tissue samples can all be billed on separate statements. That is why two people who had the same procedure can see very different totals.

Self-pay prices for an upper endoscopy cover a wide span. MDsave estimates a national average of $4,412, which sits near the top of its range. By contrast, Sidecar Health reports an average cash price of $1,109 at a surgery center and $1,595 at an outpatient hospital.

Those numbers are far apart because one source gives a national estimate that may include hospital-based pricing, while the other breaks prices out by setting. Where the procedure is done matters a great deal. If your doctor says more than one location is appropriate, ask for a price at each.

A surgery center's average cash price is made up of several fees. The figures below come from Sidecar Health and describe a surgery center setting. They are components of a bill, and not every patient is charged for every line.

When you ask for a quote, find out which of these are rolled into a single price and which are billed separately:

• Gastroenterologist visit: A consultation before the procedure may be a separate charge.
• Provider fee: This is the doctor's fee for performing the exam, and the quoted figure includes one or more biopsies.
• Facility fee: The surgery center or hospital charges this for the room, equipment and staff.
• Anesthesia: Sedation is often billed by a separate anesthesia practice.
• Pathology: If tissue samples are taken, the lab that examines them typically bills on its own.

If you have health insurance, what you pay depends on your plan design, not on the average cash prices above. A plan with a high deductible may leave you responsible for most of the allowed amount until you reach it, while a plan with a lower deductible may cover more up front.

Before the procedure, it helps to confirm:

1. Network status for every party. The doctor, the facility and the anesthesia provider can each be in or out of network, and one out-of-network bill can change the total.
2. Prior authorization. Some plans require approval ahead of time. Your doctor's office can usually tell you whether it has been requested.
3. Your deductible and out-of-pocket maximum. Ask how much of each you have already met this year.
4. Whether the procedure is coded as diagnostic. The reason for the procedure can affect how a plan processes the claim, so ask your doctor's billing office what code will be used.

Your insurer's customer service line can give you an estimate once you have the procedure code and the facility name.

The setting is one of the clearest drivers of price. Sidecar Health reports average cash prices of $1,109 at a surgery center versus $1,595 at an outpatient hospital. A hospital outpatient department often charges a larger facility fee than a freestanding surgery center.

Which location is right is a medical and logistical decision for you and your gastroenterologist. Some patients are directed to a hospital because of their health history or available equipment. A licensed doctor can explain whether a surgery center is an option for you.

National estimates and setting-specific averages are built differently, and that is a good reason to read each one carefully.

MDsave shows a range for the procedure, and the average it reports is near the upper end. That kind of skew can happen when hospital prices pull the average up. Other sources use claims data or listed cash prices from a particular setting. Dates matter too, since pricing can change from year to year.

• Ask for the self-pay price in writing: Request an itemized estimate that lists the doctor, facility, anesthesia and pathology.
• Compare locations: If your doctor works at more than one facility, ask for a quote at each.
• Check posted hospital prices: Hospitals publish prices online, and the file may list a cash rate.
• Use price-comparison tools: Some services list prepaid cash prices by location.
• Ask about financial assistance: Nonprofit hospitals commonly have programs that reduce bills based on income.
• Ask about payment plans: Many facilities will spread the cost over several months.
• Review the bill: Check the itemized statement for duplicate charges and confirm each provider's network status.

• Is the quote all-inclusive, or are anesthesia and pathology billed separately?
• Will I receive more than one bill?
• Does the price include biopsies if the doctor takes samples?
• Is the facility in network for my plan?
• Is there a discount if I pay in advance?

A doctor can explain why the procedure is being recommended. For billing questions, the facility's financial counselor is usually the best person to speak with.