How Much Does Flexible Sigmoidoscopy with Endoscopic Ultrasound and Fine Needle Aspiration Biopsy Cost?

Most of the difference is hospital pricing, not the medicine. The procedure itself is essentially the same everywhere — what changes is what the facility charges:

• Hospitals set their own prices. There's no national price for a procedure, so two hospitals — even in the same city — can charge wildly different amounts for identical care.
• Local costs differ. Wages, rent, and malpractice insurance are far higher in big metros (e.g. San Francisco, New York) than in smaller cities. Medicare adjusts the doctor's fee for this, but only modestly; hospital charges swing much more.
• Competition matters. In areas with few hospitals or one dominant health system, prices tend to run higher. Competitive markets push them down.
• Insurer contracts vary by region, which moves both the negotiated and cash prices.

💡 Because the difference is mostly pricing power — not quality — it's worth comparing hospitals and asking for the cash/self-pay rate, which is often far below the list price.