Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Medicare pricing data for 22,102 providers across 52 states
This procedure has a 6.8x markup — hospitals charge $938.06 but Medicare allows only $137.75. Uninsured patients may face bills 6.8 times higher than what insurance negotiates. 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
Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS code 43235) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $137.75, but hospitals typically charge $938.06 — a 6.8x 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 $137.75, your out-of-pocket cost would be approximately $27.55. 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 6.8x more than what Medicare allows for this procedure. Medicare actually pays $107.32 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $196 | $2,042 | 66 | 621 | +42.3% |
| Puerto Rico | $175 | $360 | 39 | 76 | +27.2% |
| Hawaii | $173 | $1,228 | 73 | 566 | +25.7% |
| California | $161 | $1,099 | 1,939 | 20,659 | +17.1% |
| Nevada | $161 | $1,323 | 143 | 1,739 | +16.6% |
| New Mexico | $159 | $758 | 88 | 1,225 | +15.2% |
| Wyoming | $155 | $1,139 | 44 | 314 | +12.9% |
| Oregon | $152 | $959 | 307 | 3,532 | +10.4% |
| Colorado | $151 | $1,605 | 350 | 3,622 | +9.9% |
| Washington | $150 | $668 | 486 | 5,628 | +9.1% |
| Mississippi | $149 | $1,001 | 165 | 4,580 | +7.8% |
| Florida | $148 | $881 | 1,440 | 18,299 | +7.2% |
| Maryland | $145 | $789 | 453 | 5,615 | +5.5% |
| Pennsylvania | $144 | $757 | 1,156 | 14,113 | +4.4% |
| North Carolina | $144 | $904 | 777 | 10,100 | +4.4% |
| Delaware | $142 | $802 | 80 | 1,154 | +3.4% |
| New York | $142 | $1,295 | 1,467 | 11,098 | +2.9% |
| Michigan | $140 | $630 | 789 | 8,866 | +1.9% |
| Utah | $140 | $1,011 | 161 | 2,533 | +1.4% |
| New Jersey | $139 | $1,271 | 631 | 4,465 | +1.1% |
| Connecticut | $139 | $1,059 | 285 | 2,234 | +0.9% |
| Arizona | $138 | $762 | 403 | 5,591 | +0.4% |
| Rhode Island | $138 | $753 | 73 | 774 | +0.1% |
| Georgia | $138 | $836 | 624 | 7,024 | +0.0% |
| Indiana | $137 | $1,183 | 462 | 8,128 | -0.3% |
| Idaho | $137 | $533 | 100 | 1,431 | -0.5% |
| Kansas | $137 | $984 | 209 | 4,712 | -0.6% |
| South Carolina | $136 | $793 | 363 | 7,615 | -1.3% |
| Ohio | $135 | $826 | 1,003 | 12,542 | -2.2% |
| Louisiana | $134 | $683 | 309 | 4,583 | -2.4% |
| Texas | $134 | $1,127 | 1,501 | 17,914 | -2.6% |
| Tennessee | $134 | $831 | 462 | 9,942 | -3.0% |
| Nebraska | $132 | $876 | 153 | 2,857 | -4.5% |
| Iowa | $132 | $1,005 | 198 | 2,764 | -4.5% |
| Arkansas | $129 | $661 | 206 | 3,557 | -6.3% |
| Minnesota | $129 | $895 | 463 | 4,385 | -6.7% |
| Massachusetts | $128 | $903 | 675 | 8,835 | -7.3% |
| Illinois | $126 | $1,063 | 845 | 9,084 | -8.8% |
| Alabama | $123 | $876 | 328 | 4,878 | -11.0% |
| Missouri | $122 | $829 | 493 | 8,214 | -11.3% |
| Oklahoma | $122 | $590 | 225 | 4,373 | -11.7% |
| Montana | $121 | $542 | 66 | 1,109 | -12.1% |
| New Hampshire | $119 | $1,645 | 114 | 1,730 | -13.9% |
| Virginia | $117 | $707 | 574 | 6,703 | -15.3% |
| District of Columbia | $116 | $877 | 77 | 634 | -15.5% |
| Maine | $115 | $542 | 92 | 948 | -16.8% |
| Kentucky | $115 | $632 | 344 | 4,096 | -16.8% |
| Vermont | $114 | $1,167 | 34 | 510 | -16.9% |
| South Dakota | $114 | $777 | 78 | 1,033 | -17.0% |
| Wisconsin | $113 | $1,769 | 469 | 4,322 | -17.9% |
| North Dakota | $111 | $1,000 | 60 | 1,013 | -19.7% |
| West Virginia | $104 | $473 | 120 | 1,390 | -24.3% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber