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National price data · 2,470 hospitals

Upper endoscopy with biopsy cost

What a upper endoscopy with biopsy costs across the U.S. — and the fair price to aim for.

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
1.00×vs. Fair Market Price
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here match the fair market benchmark (1.00×) after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Carle Richland Memorial Hospital prices routine shoppable procedures near 4.1× Medicare (p50 3.38×) while skewing captive emergency, lab, and upper-quartile codes to 6.5× Medicare (p75 3.57×, +6% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#126 of 126 in IL · 99th State Percentile#3,359 of 3,385 in U.S. · 99th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 2.33× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 11% of shoppable procedures (25/100 Cash Honesty)
  • 2-Star CMS clinical rating with 60% patient recommendation (65/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (23.5% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Even at low-cost facilities (1.00× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
  • Captive ER (5.9×) & laboratory (10.4×) services average 1.59× higher multiples than routine shoppable care (4.1×)
  • Even at low-cost facilities (1.00× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
  • Unnegotiated chargemaster list prices average 17.0× Medicare (14¢ true HCRIS cost per $1 gross)
Front-Door ShoppableElective / Imaging
4.1× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.59× Divergence
6.5× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+6% Upper Tail
Q25 2.33× · Q50 3.38× · Q75 3.57×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
4.1× MedicareElevated
Outpatient Surgery & ORBack-Door Captive
1.0× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
5.8× MedicareWatchout
Back-Door Captive ER VisitsBack-Door Captive
5.9× MedicareWatchout
Inpatient Lab & PathologyBack-Door Captive
10.4× MedicareWatchout
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.0× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
11% Cash Edge · 25/100Watchout
CMS Clinical Safety & Star ValueIntegrity & Outcomes
2 CMS · 65/100Fair
National Geographic Price Intelligence · 50-State + DC/PR Cartogram

National State Price Index Heatmap · Upper endoscopy with biopsy

State commercial price index vs. U.S. median (1.00×) and average Medicare multiple across all 53 priced states & territories

<0.93× Below Fair Price 0.93–1.05× Near Average 1.05–1.18× Elevated >1.18× High-Cost State
MT0.35×0.6× MedPR0.35×0.3× MedVT0.35×0.8× MedWY0.35×0.8× MedIA0.36×0.8× MedOR0.37×0.9× MedCT0.39×0.9× MedID0.41×1.0× MedMI0.44×1.0× MedME0.46×1.1× MedWV0.58×1.4× MedAK0.79×1.9× MedAL0.87×2.1× MedLA0.87×2.1× MedKS0.90×2.1× MedNC0.90×2.1× MedAR0.91×2.1× MedMN0.92×2.2× MedTN0.92×2.2× MedKY0.94×2.2× MedNE0.94×2.2× MedSD0.94×2.2× MedND0.95×2.2× MedPA0.95×2.2× MedCO0.96×2.3× MedOH0.97×2.3× MedSC0.97×2.3× MedTX0.97×2.3× MedIN0.99×2.3× MedIL1.00×2.4× MedNH1.02×2.4× MedNM1.02×2.4× MedAZ1.03×2.4× MedNV1.05×2.5× MedMO1.10×2.6× MedOK1.12×2.6× MedFL1.15×2.7× MedHI1.15×2.7× MedMA1.15×2.7× MedMS1.15×2.7× MedNY1.15×2.7× MedWA1.20×2.8× MedCA1.21×2.8× MedDE1.25×2.9× MedUT1.25×2.9× MedMD1.27×3.0× MedWI1.29×3.0× MedRI1.45×3.4× MedNJ1.84×4.3× MedDC1.93×4.5× MedVA1.95×4.6× MedGA2.33×5.5× Med
5 Lowest-Price States (Confounder-Isolated Value Leaders)
MT0.35×(0.6×)PR0.35×(0.3×)VT0.35×(0.8×)WY0.35×(0.8×)IA0.36×(0.8×)
5 Highest-Markup States (Strict Bill Audit Recommended)
GA2.33×(5.5×)VA1.95×(4.6×)DC1.93×(4.5×)NJ1.84×(4.3×)RI1.45×(3.4×)
The BaseRate high confidence
$991
the fair national price for a upper endoscopy with biopsy
typically $234–$2,594 across 2,470 hospitals · how we calculate it
modeled estimate · not a bill or quote
2,470
hospitals priced
52
states
11.1×
price spread — where shopping matters
2.4×
vs. Medicare

Across 2,470 hospitals in 52 states, a upper endoscopy with biopsy has a fair BaseRate of $991 and typically costs $234–$2,594. The cheapest state is PR; the priciest is GA.

Cheapest hospitals for a upper endoscopy with biopsy

Upper endoscopy with biopsy cost by state

AK $780 6 hospitals AL $862 41 hospitals AR $895 34 hospitals AZ $1,021 44 hospitals CA $1,190 170 hospitals CO $950 50 hospitals CT $380 15 hospitals DC $1,903 5 hospitals DE $1,235 7 hospitals FL $1,137 137 hospitals GA $2,303 73 hospitals HI $1,135 13 hospitals IA $352 62 hospitals ID $402 22 hospitals IL $991 90 hospitals IN $982 77 hospitals KS $884 74 hospitals KY $923 39 hospitals LA $861 57 hospitals MA $1,133 40 hospitals MD $1,251 2 hospitals ME $452 23 hospitals MI $435 68 hospitals MN $906 59 hospitals MO $1,083 62 hospitals MS $1,132 44 hospitals MT $239 13 hospitals NC $893 51 hospitals ND $938 11 hospitals NE $932 49 hospitals NH $1,004 13 hospitals NJ $1,819 45 hospitals NM $1,002 10 hospitals NV $1,036 16 hospitals NY $1,132 71 hospitals OH $960 106 hospitals OK $1,104 36 hospitals OR $368 26 hospitals PA $939 92 hospitals PR $124 5 hospitals RI $1,430 6 hospitals SC $956 43 hospitals SD $926 13 hospitals TN $911 66 hospitals TX $958 219 hospitals UT $1,233 34 hospitals VA $1,925 59 hospitals VT $349 9 hospitals WA $1,185 49 hospitals WI $1,275 91 hospitals WV $571 15 hospitals WY $316 8 hospitals
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at U.S. Hospital Benchmark (Zero PHI Required)

Fair BaseRate™ $991
Medicare Rate $575
Self-Pay Cash Request Quote
Insurer Median $987
Pre-filled with U.S. Hospital Benchmark’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $860 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $860

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $860).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask U.S. Hospital Benchmark's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$1,378 Above Fair BaseRate

Negotiate Toward $991 Fair BaseRate ($575 Medicare)

Your bill ($2,369) is $1,378 above the denoised Fair BaseRate ($991) and 4.1× the $575 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Inpatient MS-DRG vs. Outpatient CPT Care-Setting Savings

Upper GI Endoscopy (EGD) with BiopsyDRG 392 vs CPT 43239
Inpatient: $21,785Outpatient: $3,841 Save $17,944 outpatient

Clinical Scope Note:Inpatient MS-DRG reflects a multi-day hospital admission (room, nursing, higher clinical acuity); outpatient CPT reflects the outpatient facility fee for clinically eligible low-acuity patients and excludes separate surgeon and anesthesia professional fees.