Heads up: If tissue samples are taken, billing upgrades to CPT 43239. Biopsy during endoscopy is common — budget for it.
An upper endoscopy (also called EGD — esophagogastroduodenoscopy) uses a camera to look at your esophagus, stomach, and upper small intestine. A basic diagnostic scope is CPT 43235. If the doctor takes a tissue sample, it becomes 43239. Additional codes apply if dilation is performed.
Tip: Use CPT 43235 as your cost baseline. Most upper endoscopies for reflux or ulcer evaluation bill as 43235 or 43239.
| Code | Variant | When it applies | |
|---|---|---|---|
| CPT 43235 | Diagnostic | Camera exam only | See exact rates → |
| CPT 43239 | With biopsy | Tissue sample taken | See exact rates → |
| CPT 43240 | With dilation | Narrowing widened during procedure | See exact rates → |
Ranges span all billing codes for this procedure. Actual rate depends on which variant is performed.
| Insurance | AdventHealth Tampa | AdventHealth Wesley Chapel | AdventHealth Zephyrhills | HCA Florida Brandon Hospital | HCA Florida Largo Hospital | HCA Florida South Tampa Hospital | HCA Florida Trinity Hospital | HCA Florida West Tampa Hospital |
|---|---|---|---|---|---|---|---|---|
| Molina | $709Best | $709Best | $709Best | $2,326 | $2,326 | $2,326 | $2,326 | $2,326 |
| Humana | $864Best | $2,518 | $1,884 | — | — | — | — | — |
| Workers Comp | — | — | — | $1,849–$2,049Best | $1,849–$2,049Best | $1,849–$2,049Best | $1,849–$2,049Best | $1,849–$2,049Best |
| Blue Cross Blue Shield | — | — | — | $1,894–$9,962Best | $1,894–$9,962Best | $2,480–$13,675 | $2,473–$13,329 | $2,480–$13,675 |
| Aetna | $2,216Best | $2,767 | $2,820 | — | — | — | — | — |
| Oscar Health | $1,680Best | $1,744 | $1,913 | $3,662–$6,965 | $3,662–$6,965 | $3,662–$6,965 | $3,662–$6,965 | $3,662–$6,965 |
| Cigna | $2,220 | $1,922Best | $1,946 | $7,480 | $7,480 | $7,480 | $7,480 | $7,480 |
| Multiplan | $6,131Best | $7,112 | $7,112 | — | — | — | — | — |
Source: Hospital price transparency files (federally required). Facility fees only.
Each hospital negotiates separate contracts with every insurer. For the same procedure, the rate can differ by 3–5x between hospital systems — larger systems have more leverage and command higher rates.
Facility fee only. The physician performing this procedure bills separately. Your out-of-pocket depends on your deductible and coinsurance. Federal law requires hospitals to provide a Good Faith Estimate before any non-emergency procedure.