Cost analysis for CPT 43235 — Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Average Medicare Payment
$100.67
2023 data
Total Payments (2023)
$24.1M
Services (2023)
218.6K
Price Change (2014–2023)
-6.3%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $107.39 | $44.6M | 387.6K | — |
| 2015 | $109.84 | $44.0M | 371.4K | +2.3% |
| 2016 | $106.58 | $43.0M | 372.3K | -3.0% |
| 2017 | $102.88 | $39.7M | 356.8K | -3.5% |
| 2018 | $103.75 | $38.6M | 343.7K | +0.8% |
| 2019 | $104.84 | $37.9M | 333.0K | +1.1% |
| 2020 | $105.16 | $27.7M | 243.8K | +0.3% |
| 2021 | $104.88 | $29.1M | 253.4K | -0.3% |
| 2022 | $103.51 | $26.3M | 231.1K | -1.3% |
| 2023 | $100.67 | $24.1M | 218.6K | -2.7% |
The most expensive state pays 2.2x more than the cheapest for this procedure. AK averages $174.27 vs WV at $79.05.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $174.27 | $76.9K | 441 | 21 |
| HI | $156.06 | $58.4K | 374 | 16 |
| NM | $133.08 | $132.3K | 994 | 27 |
| WY | $129.57 | $24.0K | 185 | 9 |
| CA | $129.36 | $2.0M | 15.7K | 571 |
| NV | $128.34 | $187.9K | 1.5K | 53 |
| OR | $127.47 | $335.3K | 2.6K | 97 |
| CO | $124.47 | $344.5K | 2.8K | 123 |
| WA | $121.51 | $526.4K | 4.3K | 181 |
| FL | $119.31 | $1.7M | 14.5K | 473 |
| MS | $118.60 | $504.6K | 4.3K | 84 |
| PA | $117.14 | $1.3M | 11.2K | 410 |
| CT | $117.02 | $156.1K | 1.3K | 69 |
| NC | $116.56 | $960.1K | 8.2K | 283 |
| MD | $116.27 | $536.6K | 4.6K | 157 |
| MI | $115.92 | $793.3K | 6.8K | 237 |
| DE | $113.99 | $113.3K | 994 | 29 |
| RI | $113.06 | $59.0K | 522 | 21 |
| GA | $111.41 | $606.2K | 5.4K | 208 |
| AZ | $110.96 | $511.0K | 4.6K | 161 |
| NY | $110.09 | $782.2K | 7.1K | 316 |
| UT | $109.97 | $233.3K | 2.1K | 55 |
| OH | $109.90 | $1.1M | 10.1K | 373 |
| SC | $109.56 | $749.2K | 6.8K | 165 |
| KS | $109.16 | $468.0K | 4.3K | 99 |
| IN | $109.02 | $787.0K | 7.2K | 208 |
| LA | $107.46 | $404.6K | 3.8K | 107 |
| TX | $107.23 | $1.5M | 13.8K | 462 |
| MN | $107.05 | $330.6K | 3.1K | 136 |
| NJ | $106.89 | $273.7K | 2.6K | 125 |
| ID | $106.85 | $129.9K | 1.2K | 45 |
| IA | $106.84 | $250.1K | 2.3K | 72 |
| TN | $106.00 | $962.9K | 9.1K | 217 |
| NE | $104.16 | $269.2K | 2.6K | 68 |
| AR | $102.28 | $318.0K | 3.1K | 78 |
| MA | $100.90 | $725.6K | 7.2K | 249 |
| IL | $98.84 | $660.9K | 6.7K | 259 |
| AL | $97.56 | $402.0K | 4.1K | 129 |
| MO | $96.15 | $691.2K | 7.2K | 226 |
| OK | $95.42 | $376.8K | 3.9K | 96 |
| ME | $93.59 | $70.8K | 757 | 33 |
| NH | $93.09 | $140.3K | 1.5K | 55 |
| MT | $92.92 | $91.2K | 981 | 24 |
| KY | $91.44 | $297.5K | 3.3K | 123 |
| SD | $89.98 | $78.1K | 868 | 32 |
| DC | $88.77 | $37.9K | 427 | 22 |
| WI | $88.49 | $271.9K | 3.1K | 136 |
| VA | $87.83 | $474.6K | 5.4K | 183 |
| VT | $87.58 | $39.8K | 454 | 18 |
| ND | $83.89 | $76.7K | 914 | 23 |
| WV | $79.05 | $89.2K | 1.1K | 40 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Los Angeles Endoscopy Center | Ambulatory Surgical Center | CA | $142.5K | 398 | $358.08 |
| Greenville Endoscopy Center Inc | Ambulatory Surgical Center | SC | $102.2K | 523 | $195.39 |
| Digestivecare, Llc | Ambulatory Surgical Center | TN | $99.1K | 477 | $207.77 |
| Center For Digestive Health Llc | Ambulatory Surgical Center | MS | $93.5K | 404 | $231.34 |
| The Scranton Pa Endoscopy Asc Lp | Ambulatory Surgical Center | PA | $80.1K | 313 | $255.85 |
| Mngi Endoscopy Asc Inc | Ambulatory Surgical Center | MN | $72.6K | 241 | $301.43 |
| Beltway Surgery Centers, L.L.C. | Ambulatory Surgical Center | IN | $70.1K | 233 | $301.04 |
| Cotton-Oneil Clinic Endoscopy Center Rvoc Tr | Ambulatory Surgical Center | KS | $69.8K | 338 | $206.39 |
| North Shore Endoscopy Center, Llc | Ambulatory Surgical Center | OH | $63.5K | 281 | $225.95 |
| The Endoscopy Center At St. Francis, Llc | Ambulatory Surgical Center | IN | $53.6K | 188 | $285.13 |
| Digestive Diseases Center Of Hattiesburg, Llc | Ambulatory Surgical Center | MS | $50.3K | 232 | $216.98 |
| Jacksonville Endoscopy Centers Llc | Ambulatory Surgical Center | FL | $49.3K | 200 | $246.56 |
| Jacksonville Endoscopy Centers Llc | Ambulatory Surgical Center | FL | $47.7K | 229 | $208.14 |
| Endoscopy Center Of Santa Fe Lp | Ambulatory Surgical Center | NM | $47.2K | 179 | $263.94 |
| Cape And Islands Endoscopy Center Llc | Ambulatory Surgical Center | MA | $45.2K | 163 | $277.28 |
| Midwest Endoscopy Services Llc | Ambulatory Surgical Center | NE | $45.1K | 228 | $197.73 |
| Hattiesburg Clinic Pa | Ambulatory Surgical Center | MS | $44.7K | 205 | $217.91 |
| Outpatient Surgery Center Of Jonesboro Llc | Ambulatory Surgical Center | AR | $44.6K | 194 | $229.87 |
| Amarillo Surgery And Endoscopy, Lp | Ambulatory Surgical Center | TX | $43.4K | 199 | $218.31 |
| Berks Center For Digestive Health, Lp | Ambulatory Surgical Center | PA | $42.8K | 169 | $253.26 |
The data suggests significant pricing inconsistencies for CPT 43235. With a 2.2x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
While costs have decreased 6.3% since 2014, the wide state-by-state variation suggests the pricing formula may not adequately account for regional differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.