Cost of a EGD with Biopsy Visit
in South Dakota
Reviewed by Momentary Medical Group West PC
South Dakota's rural healthcare infrastructure creates unique cost dynamics for specialized procedures, with EGD with Biopsy services concentrated in larger medical centers like Sioux Falls and Rapid City. Patients across the state typically pay between $85 and $2,396 for upper endoscopy with biopsy procedures, with a median out-of-pocket cost of $332 based on negotiated insurance rates. South Dakota has 77 active EGD with Biopsy providers serving the state's scattered population, creating both accessibility challenges and cost variations depending on geographic location.
Average
$938
Median
$332
Lowest
$85
Highest
$2,396
Providers
77
74% above national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in South Dakota?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $85 | $345 | $2,255 | 79 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $80 | $389 | $1,035 | 66 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $80 | $491 | $1,090 | 61 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $103 | $275 | $691 | 52 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $26 | $26 | $26 | 328 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $67 | $169 | $460 | 73 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $68 | $68 | $117 | 309 |
Important: These are cost estimates only — not a quote and not medical advice.
The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 43239 — EGD with biopsy). They represent what a patient might pay without insurance.
Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.
This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.
Where this data comes from & what CPT 43239 covers
Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 43239 (EGD with biopsy), as mandated by the CMS Price Transparency Rule.
What CPT 43239 covers: the provider's professional fee for upper endoscopy with biopsy. It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.
How to read this data
Negotiated Rate
The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.
P5, Median, P95
P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.
What this does not tell you
These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.
Why EGD with Biopsy Visit Costs Vary Across South Dakota
South Dakota's healthcare costs run approximately 3% above the national average despite lower overall living costs, reflecting the challenges of delivering specialized care across vast rural distances. The state's sparse population density creates unique cost pressures, as fixed overhead for advanced medical equipment must be spread across fewer procedures.
Urban vs. Rural Provider Availability
EGD with Biopsy services are heavily concentrated in Sioux Falls and Rapid City, forcing many rural residents to travel significant distances for care. This geographic reality creates both transportation costs for patients and higher facility overhead for providers serving dispersed populations. Some regional hospitals offer visiting gastroenterologist services, but most complex endoscopic procedures require referral to major medical centers.
Facility Type and Overhead Costs
Hospital outpatient departments at Sanford and Avera health systems typically charge higher facility fees than independent ambulatory surgery centers, reflecting different overhead structures and regulatory requirements. Many South Dakota hospitals operate as critical access facilities with unique Medicare reimbursement arrangements that can affect pricing strategies. The limited number of independent gastroenterology practices reduces competitive pressure on hospital-based pricing.
Insurance Market Competition in South Dakota
Wellmark Blue Cross Blue Shield holds dominant market share across South Dakota, followed by Sanford Health Plan and UnitedHealthcare, creating limited insurer competition that can result in higher negotiated rates. The state's small population and rural geography make it less attractive for national insurers to enter the market aggressively. This concentration gives existing insurers significant leverage in provider contract negotiations, though outcomes vary by health system.
Physician Supply and Demand in South Dakota
With 77 active EGD with Biopsy providers serving approximately 885,000 residents, South Dakota maintains adequate gastroenterology capacity in urban areas but faces shortages in rural regions. This geographic maldistribution creates longer wait times and higher costs in underserved areas, as limited competition allows providers to maintain premium pricing. Recruitment challenges for specialists in rural South Dakota contribute to the concentration of services in major metropolitan areas.
Jayant Panwar
CEO, Momentary Labs · San Francisco, CA
Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.
The cost figures on this page reflect his ongoing work to make this data accessible to patients.
Frequently Asked Questions — EGD with Biopsy Costs in South Dakota
What is the average cost of a EGD with Biopsy visit in South Dakota without insurance?
Does South Dakota Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in South Dakota?
What is the difference in cost between an initial consultation and a follow-up visit?
Can I use an HSA or FSA to pay for a EGD with Biopsy visit in South Dakota?
How does telemedicine affect the cost of seeing a EGD with Biopsy in South Dakota?
Click a state to compare costs
Average Visit Cost
Office visit (CPT 43239)
Compare With Other States
| Rank | State | Average↓ |
|---|---|---|
| 1 | Wisconsin Range: $116 – $5,357 | $2,029 |
| 2 | North Dakota Range: $181 – $2,396 | $1,658 |
| 3 | Minnesota Range: $90 – $2,396 | $1,627 |
| 4 | South Dakota Range: $85 – $2,396 | $938 |
| 5 | Massachusetts Range: $80 – $1,654 | $747 |
| 6 | New York Range: $166 – $1,647 | $743 |
| 7 | New Hampshire Range: $341 – $1,085 | $715 |
| 8 | Rhode Island Range: $80 – $1,647 | $715 |
| 9 | Connecticut Range: $85 – $1,647 | $711 |
| 10 | Delaware Range: $80 – $1,647 | $684 |
| 11 | West Virginia Range: $80 – $1,647 | $675 |
| 12 | Pennsylvania Range: $80 – $1,647 | $666 |
| 13 | Maine Range: $404 – $783 | $631 |
| 14 | Nebraska Range: $195 – $902 | $629 |
| 15 | Oregon Range: $80 – $1,352 | $553 |
| 16 | Vermont Range: $273 – $907 | $552 |
| 17 | Wyoming Range: $173 – $1,151 | $549 |
| 18 | California Range: $80 – $1,352 | $542 |
| 19 | Georgia Range: $85 – $1,084 | $522 |
| 20 | Iowa Range: $85 – $902 | $516 |
| 21 | New Jersey Range: $83 – $1,165 | $508 |
| 22 | District of Columbia Range: $86 – $995 | $504 |
| 23 | North Carolina Range: $80 – $1,088 | $495 |
| 24 | Missouri Range: $130 – $712 | $436 |
| 25 | Utah Range: $80 – $820 | $428 |
| 26 | New Mexico Range: $90 – $834 | $424 |
| 27 | Washington Range: $80 – $954 | $423 |
| 28 | Hawaii Range: $80 – $903 | $411 |
| 29 | Maryland Range: $121 – $810 | $401 |
| 30 | Indiana Range: $80 – $810 | $399 |
| 31 | Colorado Range: $85 – $829 | $383 |
| 32 | Kentucky Range: $60 – $830 | $370 |
| 33 | Illinois Range: $70 – $696 | $368 |
| 34 | Arkansas Range: $85 – $712 | $361 |
| 35 | Virginia Range: $90 – $728 | $358 |
| 36 | Idaho Range: $80 – $802 | $356 |
| 37 | Michigan Range: $80 – $685 | $341 |
| 38 | Mississippi Range: $114 – $621 | $340 |
| 39 | Kansas Range: $130 – $526 | $333 |
| 40 | Louisiana Range: $85 – $634 | $331 |
| 41 | Texas Range: $80 – $649 | $320 |
| 42 | Ohio Range: $85 – $621 | $309 |
| 43 | South Carolina Range: $80 – $627 | $306 |
| 44 | Alabama Range: $80 – $566 | $305 |
| 45 | Nevada Range: $85 – $571 | $304 |
| 46 | Tennessee Range: $85 – $604 | $296 |
| 47 | Oklahoma Range: $85 – $569 | $264 |
| 48 | Alaska Range: $80 – $606 | $255 |
| 49 | Florida Range: $35 – $659 | $250 |
| 50 | Arizona Range: $81 – $493 | $245 |
| 51 | Montana Range: $80 – $523 | $228 |