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Upper Endoscopy With Ultrasound-Guided Biopsy

Nationwide rates for HCPCS 43242

A flexible camera is passed through the mouth into the food pipe, stomach and first part of the small intestine, with an ultrasound probe on its tip that sees through the gut wall into nearby organs such as the pancreas, bile duct and lymph nodes. A fine needle is then passed through the wall under ultrasound guidance to take samples from a lump or gland. The ultrasound survey covers the full upper tract rather than one area alone.

Rates data updated July 2026.

How much does Upper Endoscopy With Ultrasound-Guided Biopsy cost?

$3,517

Typical total for the visit. Nationwide, July 2026.

Insurers have agreed to pay about $3,517 for this procedure. That total is two separate charges: $355 to the doctor who performs it, and $3,162 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 62 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$355$257 to $562
Facility feeThe hospital or surgery center$3,162$1,175 to $5,370

How much rates vary

Facilitymedian $3,162 · 10th to 90th $437 to $8,511Professionalmedian $355 · 10th to 90th $234 to $1,380
$200$500$1K$2K$5K$10K$20Kfacility $3,162professional $355

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$3,548.13
Typical High
$8,511.38
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$4,168.69
Typical High
$10,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$831.76
Typical High
$2,187.76
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$2,511.89
Typical High
$6,025.60

What it costs in each state

The same service costs 4.8 times more in California than in Oregon. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Touch or drag across the chart to see any state's rate.

CA $4,730OR $991

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.