Cost of a Upper Endoscopy Visit
in Wisconsin
Reviewed by Momentary Medical Group West PC
Wisconsin's healthcare system serves 5.9 million residents through a mix of major academic medical centers and rural critical access hospitals, creating significant variation in Upper Endoscopy procedure costs across the state. Patients typically pay between $130 and $4,430 for an Upper Endoscopy, with a median negotiated rate of $529 based on transparency data from 1,916 active providers. Wisconsin's robust network of gastroenterology specialists and hospital-based endoscopy centers gives patients multiple options when seeking Upper Endoscopy services throughout the state.
Average
$1,697
Median
$529
Lowest
$130
Highest
$4,430
Providers
1,916
343% above national average
Compare Similar Procedures
How does upper endoscopy (egd) 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 with Biopsy Upper GI endoscopy with biopsy | 43239 | $116 | $615 | $5,357 | 2,133 |
| 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 43235 — EGD, diagnostic). 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 43235 covers
Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 43235 (EGD, diagnostic), as mandated by the CMS Price Transparency Rule.
What CPT 43235 covers: the provider's professional fee for upper endoscopy (egd). 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 Upper Endoscopy Visit Costs Vary Across Wisconsin
Wisconsin's healthcare costs run approximately 1% above the national average, reflecting the state's mix of urban medical centers and rural provider challenges. The concentration of major health systems in Milwaukee and Madison creates competitive pricing in these metros, while northern and rural counties face higher costs due to limited provider availability.
Urban vs. Rural Provider Availability
Milwaukee and Madison areas offer abundant gastroenterology specialists and outpatient endoscopy centers, creating competitive pricing and shorter wait times for Upper Endoscopy procedures. Rural Wisconsin counties, particularly in the north, often require patients to travel 50+ miles to access endoscopy services, with limited options driving up costs at available facilities.
Facility Type and Overhead Costs
Wisconsin's dominant health systems like Advocate Aurora Health, Ascension Wisconsin, and UW Health operate hospital-based endoscopy suites with higher facility fees compared to independent gastroenterology practices. Ambulatory surgery centers throughout the state typically offer Upper Endoscopy at 30-50% lower facility costs than hospital outpatient departments.
Insurance Market Competition in Wisconsin
Strong competition between BCBS Wisconsin, UnitedHealthcare, and regional players like WEA Trust helps maintain competitive negotiated rates for Upper Endoscopy procedures. Wisconsin's relatively concentrated insurance market allows major health systems to negotiate favorable rates, though smaller independent practices may face pressure on reimbursement levels.
Physician Supply and Demand in Wisconsin
Wisconsin's 1,916 Upper Endoscopy providers create adequate supply in urban areas but shortages persist in rural regions, particularly the northern counties. This geographic imbalance drives higher costs and longer wait times in underserved areas, while metro regions maintain competitive pricing due to abundant specialist availability.
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 — Upper Endoscopy Costs in Wisconsin
What is the average cost of a Upper Endoscopy visit in Wisconsin without insurance?
Does Wisconsin Medicaid cover Upper Endoscopy visits?
How do I find an affordable Upper Endoscopy 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 Upper Endoscopy visit in Wisconsin?
How does telemedicine affect the cost of seeing a Upper Endoscopy in Wisconsin?
Click a state to compare costs
Average Visit Cost
Office visit (CPT 43235)
Compare With Other States
| Rank | State | Average↓ |
|---|---|---|
| 1 | Wisconsin Range: $130 – $4,430 | $1,697 |
| 2 | Massachusetts Range: $159 – $1,259 | $625 |
| 3 | New Hampshire Range: $288 – $813 | $547 |
| 4 | Maine Range: $333 – $583 | $493 |
| 5 | Nebraska Range: $176 – $691 | $487 |
| 6 | Iowa Range: $135 – $691 | $473 |
| 7 | North Dakota Range: $118 – $853 | $440 |
| 8 | Wyoming Range: $161 – $864 | $438 |
| 9 | Georgia Range: $119 – $830 | $433 |
| 10 | North Carolina Range: $120 – $853 | $424 |
| 11 | West Virginia Range: $93 – $889 | $419 |
| 12 | Vermont Range: $211 – $673 | $415 |
| 13 | Minnesota Range: $117 – $695 | $408 |
| 14 | Washington Range: $152 – $759 | $408 |
| 15 | Rhode Island Range: $109 – $718 | $406 |
| 16 | Utah Range: $98 – $627 | $405 |
| 17 | New York Range: $159 – $771 | $401 |
| 18 | New Mexico Range: $141 – $724 | $391 |
| 19 | District of Columbia Range: $115 – $701 | $387 |
| 20 | Alaska Range: $105 – $759 | $380 |
| 21 | Connecticut Range: $118 – $683 | $367 |
| 22 | Indiana Range: $90 – $691 | $361 |
| 23 | Delaware Range: $109 – $701 | $361 |
| 24 | Pennsylvania Range: $90 – $715 | $360 |
| 25 | South Dakota Range: $103 – $691 | $356 |
| 26 | Missouri Range: $115 – $535 | $354 |
| 27 | New Jersey Range: $74 – $758 | $354 |
| 28 | Oregon Range: $85 – $691 | $346 |
| 29 | Maryland Range: $109 – $666 | $337 |
| 30 | Hawaii Range: $82 – $636 | $331 |
| 31 | Colorado Range: $117 – $627 | $329 |
| 32 | Kentucky Range: $106 – $631 | $328 |
| 33 | Michigan Range: $121 – $572 | $322 |
| 34 | Idaho Range: $86 – $623 | $316 |
| 35 | Illinois Range: $118 – $534 | $314 |
| 36 | South Carolina Range: $109 – $564 | $305 |
| 37 | Montana Range: $90 – $581 | $301 |
| 38 | Arkansas Range: $90 – $535 | $299 |
| 39 | Nevada Range: $197 – $467 | $297 |
| 40 | Virginia Range: $95 – $551 | $291 |
| 41 | Mississippi Range: $101 – $544 | $291 |
| 42 | Alabama Range: $98 – $500 | $279 |
| 43 | Texas Range: $90 – $508 | $276 |
| 44 | Louisiana Range: $96 – $484 | $270 |
| 45 | Tennessee Range: $101 – $473 | $266 |
| 46 | Oklahoma Range: $85 – $521 | $263 |
| 47 | Kansas Range: $115 – $411 | $262 |
| 48 | California Range: $80 – $598 | $254 |
| 49 | Ohio Range: $77 – $474 | $249 |
| 50 | Arizona Range: $71 – $455 | $233 |
| 51 | Florida Range: $35 – $496 | $195 |