Cost of a EGD with Biopsy Visit
in Wisconsin
Reviewed by Momentary Medical Group West PC
Wisconsin's healthcare system serves both urban centers like Milwaukee and Madison alongside extensive rural communities, creating significant cost variation for medical procedures. Patients seeking an EGD with Biopsy in Wisconsin typically pay between $115.68 and $5357.06, with a median cost of $614.94 according to negotiated insurance rates. The state's 2,133 active providers offer substantial choice for patients across Wisconsin's diverse geography.
Average
$2,029
Median
$615
Lowest
$116
Highest
$5,357
Providers
2,133
277% above national average
Compare Similar Procedures
How does upper endoscopy with biopsy compare to related procedures in Wisconsin?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Colonoscopy Diagnostic colonoscopy | 45378 | $73 | $281 | $4,430 | 4,457 |
| Colonoscopy with Biopsy Colonoscopy with biopsy | 45380 | $73 | $385 | $5,357 | 4,222 |
| Colonoscopy with Polyp Removal Colonoscopy with polyp removal by snare | 45385 | $81 | $617 | $5,357 | 2,400 |
| Upper Endoscopy (EGD) Diagnostic upper GI endoscopy | 43235 | $130 | $529 | $4,430 | 1,916 |
| ECG / EKG 12-lead electrocardiogram with interpretation | 93000 | $19 | $73 | $102 | 9,032 |
| Echocardiogram Transthoracic echocardiogram with Doppler | 93306 | $73 | $175 | $1,020 | 5,284 |
| OB Ultrasound Obstetric ultrasound, complete | 76805 | $68 | $95 | $502 | 3,783 |
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 Wisconsin
Wisconsin's healthcare costs run approximately 1% above national averages, reflecting the state's mix of major metropolitan areas and extensive rural regions. The state's geography creates distinct cost patterns between the Milwaukee-Madison corridor and northern Wisconsin's more remote communities.
Urban vs. Rural Provider Availability
Wisconsin's gastroenterology specialists are heavily concentrated in the Milwaukee, Madison, and Green Bay metropolitan areas, with limited options in rural counties. This geographic disparity means patients in northern Wisconsin may need to travel significant distances for specialized care. Rural areas often have higher per-procedure costs due to lower patient volumes and higher overhead expenses.
Facility Type and Overhead Costs
Major health systems like Froedtert, UW Health, and Ascension Wisconsin operate many hospital-based gastroenterology clinics with higher facility fees. Independent ambulatory surgery centers typically offer lower-cost alternatives for EGD with Biopsy procedures. The state's mix of academic medical centers and community hospitals creates varying cost structures across different regions.
Insurance Market Competition in Wisconsin
Blue Cross Blue Shield of Wisconsin (Anthem), UnitedHealthcare, and WEA Trust dominate the state's insurance market with moderate competition levels. This concentrated market structure gives major insurers significant negotiating power with providers. Rural areas often have fewer insurance options, which can limit patient choice and affect negotiated rates for specialty procedures.
Physician Supply and Demand in Wisconsin
Wisconsin's 2,133 active EGD with Biopsy providers represent a robust supply relative to the state's population, particularly in urban areas. However, specialist availability remains limited in rural counties, creating longer wait times and potentially higher costs for patients who cannot travel to metropolitan areas. The state's medical schools help maintain adequate specialist training pipelines for major population centers.
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 Wisconsin
What is the average cost of a EGD with Biopsy visit in Wisconsin without insurance?
Does Wisconsin Medicaid cover EGD with Biopsy visits?
How do I find an affordable EGD with Biopsy near me in Wisconsin?
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 Wisconsin?
How does telemedicine affect the cost of seeing a EGD with Biopsy in Wisconsin?
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 |