EGD (esophagogastroduodenoscopy), simple
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the EGD (esophagogastroduodenoscopy), simple Standard Service Package (SSP GA007). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS J2250 | Facility Fee | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J7120 | Facility Fee | Intravenous infusion of 1000cc of ringer's lactate solution |
| HCPCS 43248 | Facility Fee | Flexible Esophago-gastro-duodenoscopy with Guide Wire Dilatation |
| HCPCS G0121 | Professional Fee | Colonoscopy for Non-high Risk Colorectal Cancer Screening |
| HCPCS 43248 | Professional Fee | Flexible Esophago-gastro-duodenoscopy with Guide Wire Dilatation |
| Revenue Code 250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |