How much does an endoscopy cost in 2021? |

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How much does an endoscopy cost?

Compare payment options and costs for an endoscopy

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If you're a candidate for an endoscopy, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for an endoscopy before scheduling your appointment.

Average cost for an endoscopy

If you have health insurance and use an in-network doctor, you can expect to pay $3,581 for an endoscopy on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $8,693.

Average costs are based on the primary cost of an endoscopy in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.

CPT code Procedure ZIP used Description In-network costs Out-of-network costs
43235 Endoscopy 90201 Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope $3,581 $8,693

Related costs for an endoscopy

CPT code Primary procedure Description In-network costs Out-of-network costs
00731 Anesthesia Anesthesia for lower abdominal hernia repair $943 $2,240
43235 Hospital (Outpatient) Hospital Outpatient Facility (HOSPF) estimate for procedure code 43235 (in addition to your doctor's fee) $2,103 $4,668
Total related costs $3,046 $6,908

Does health insurance cover an endoscopy?

Most health insurance policies cover an endoscopy if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of an endoscopy out of pocket. The exact amount your insurance pays for an endoscopy comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking an endoscopy.

Does Medicare cover an endoscopy?

It depends on your Medicare plan, but generally Medicare covers procedures like an endoscopy that are considered medically necessary by your doctor.

  • Medicare Part A (Hospital Insurance) covers inpatient care in a hospital or skilled nursing facility following a hospital stay, so it typically won't cover an endoscopy.
  • Medicare Part B (Medical Insurance) pays for emergency, urgent and outpatient care and some preventative services, which means Medicare likely covers an endoscopy — but you'll be charged a 20% coinsurance.
  • Medicare Part C (Medicare Advantage) is a comprehensive plan that combines Part A, Part B and often Part D and should pay for a portion of an endoscopy minus any deductible, copay or coinsurance.
  • Medicare Part D (Prescription Drugs) won't cover an endoscopy, but it may help to pay for any medication you need as part of your recovery.

What affects the cost of an endoscopy?

The price you'll pay for an endoscopy varies based on factors like:

  • Your health insurance plan. Your coinsurance, copay and how much of your deductible you've met affects the amount you pay for an endoscopy out of pocket, does as whether your doctor or anyone else involved is outside your network.
  • Your location. Where you live dictates which doctors or healthcare facilities you have access to for an endoscopy. Urban areas are more competitive, which can drive down costs for an endoscopy compared to rural areas.
  • Your doctor. Your doctor's experience and expertise affects how much they charge for an endoscopy. And the cost may increase if complications arise during an endoscopy and your doctor has to call in other medical professionals.
  • Additional fees. Your healthcare provider may charge associated fees that increase the overall cost of an endoscopy.

How to cut your costs for an endoscopy

In the leadup to an endoscopy, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.

  • Dip into your HSA, FSA or HRA. These tax-advantaged accounts can help you to cover out-of-pocket costs for an endoscopy.
  • Ask about financial aid. If you can't afford to pay the average cost of $3,581 with or without insurance, most hospitals and clinics offer financial aid programs that include discounts or interest-free payment plans.
  • Explore outpatient centers. Outpatient facilities tend to charge less for medical procedures like an endoscopy, though they're not an option for everyone.
  • Consider medical loans. A medical loan could help pay for anything your health insurance doesn't cover for an endoscopy, like copays or coinsurance.
  • Compare doctors and hospitals. Lower the price of medical services by comparing in-network hospitals before you schedule an endoscopy. The Centers for Medicare and Medicaid Services require hospitals and clinics to publish online price lists for common procedures, which may include costs for an endoscopy.

Bottom line

The price of an endoscopy is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for an endoscopy can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.

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