Medicare's national average for an upper endoscopy in 2026 is $607 at an ambulatory surgery center and $1,036 at a hospital outpatient department — a range of $607 to $1,036 for the same procedure code, CPT 43235. Those totals cover the doctor's fee and the facility's fee together. A Medicare patient's own share is $121 at the surgery center and $207 at the hospital.
Medicare describes CPT 43235 as “Esophagogastroduodenoscopy, flexible, transoral; diagnostic” — in plain terms, a diagnostic upper endoscopy — a flexible scope passed through the mouth. The figures below are national averages published by CMS; your own region, and above all your own insurance status, will move them.
| Ambulatory surgery center | Hospital outpatient department | |
|---|---|---|
| Total (Medicare-approved amount) | $607 | $1,036 |
| Doctor fee | $110 | $110 |
| Facility fee | $497 | $926 |
| Medicare pays | $486 | $829 |
| Patient pays (average) | $121 | $207 |
Source: Medicare.gov Procedure Price Lookup, CPT 43235, retrieved July 29, 2026. CMS states these are national averages based on Medicare’s 2026 payments and copayments; the underlying dataset is the CMS 2026 Hospital Outpatient PPS annual policy file. Figures are rounded by CMS and are not intended to reconcile to the dollar.
The most useful thing in that table is what does not change. The doctor’s fee is $110 in both settings. What moves is the facility fee: $497 at a surgery center against $926 at a hospital outpatient department — 1.9× as much. Because the professional fee is fixed, the whole 1.7× difference in the total is the building.
Medicare.gov's own note on this procedure says the figures include facility and doctor fees, but that “you may need more than one doctor and additional costs may apply.” In practice the extra bill is usually anesthesia, and sometimes pathology. Two things from CMS's National Correct Coding Initiative Policy Manual are worth knowing before you pay any of them:
Anesthesia itself is reported from the CPT anesthesia series; the manual notes that codes 00100–01860 are the “Anesthesia for” codes tied to a surgical intervention, and that 99151–99157 describe moderate (conscious) sedation. Which specific code applies depends on the operation, so ask for the anesthesia claim in writing rather than assuming.
Everything above is what Medicare pays. It is not a cash price, it is not what a commercial insurer has negotiated, and it is certainly not a hospital’s list price. Those three numbers can differ from each other by multiples for the identical procedure code at the identical hospital.
We are deliberately not publishing a national “fair cash price” for an upper endoscopy. We do not have a current primary-source benchmark for one, and a stale number presented as today’s would be worse than no number. What we can tell you is where the number that actually governs your bill lives: your hospital publishes its own rates for CPT 43235 — the gross charge, the discounted cash price, and the payer-specific negotiated rates — in a machine-readable file. Our hospital price check walks you to it, and this guide shows how to read it once you get there.
If you just want a quick sanity check on the number in front of you, the overcharge estimator compares your charge against typical national ranges. Treat it as a smoke alarm, not a valuation.
The doctor’s fee for 43235 is $110 in either setting. Everything else on Medicare’s figure is the room — $497 at a surgery center, $926 at a hospital. If your bill is large, the line to scrutinize is almost certainly the facility charge, not the gastroenterologist’s.
If tissue was taken during your scope, the procedure performed was not the diagnostic-only service this code describes, and a different code applies. Compare the code on the bill against what the procedure report actually says was done.
If a specimen was collected it goes to a laboratory that bills separately, often from a company you never chose and after you have already paid the hospital. Check that its date of service matches your procedure date before paying it.
Have the bill in front of you? Upload it and our AI reads every line — decoding each code, flagging duplicates, upcoding and unbundling, and drafting a dispute letter for anything it flags.
Audit my bill →CPT® is a registered trademark of the American Medical Association. CPT code descriptions quoted above are reproduced only as they appear on the CMS pages cited.