Upper Endoscopy (EGD) Cost in Wisconsin
Egd diagnostic brush wash
$1,037Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
Wisconsin Medicare physician rate (2026)
-4.9% vs nationalSingle statewide locality.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $429 on the Medicare allowed amount for upper endoscopy (egd). Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in Wisconsin
Check your ZIP code for your part of Wisconsin, whether Milwaukee, Madison, Green Bay and the Fox Valley, La Crosse, Eau Claire, or the rural Northwoods.
What upper endoscopy (egd) costs at hospitals near you
Everything above is a national average. The hospital you pick in Wisconsin moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. In Wisconsin the office and hospital physician lines for this CPT differ by $203.19.
National vs Wisconsin
Where Wisconsin ranks for this CPT
Upper Endoscopy (EGD) and how Wisconsin is priced
Wisconsin's Medicare pricing runs through a single statewide locality with indices near the national average, so Milwaukee, Madison, and the Northwoods share the same approved amounts. The unified locality sits atop one of the more regionally organized care systems in the country, with strong integrated groups serving defined territories. No metro premium exists in the fee schedule, so Milwaukee's higher practice costs are averaged into the statewide factors. The published rates here travel unchanged across all seventy-two counties.
Milwaukee and Madison hold the state's academic medicine and largest systems, while integrated clinics in Marshfield, La Crosse, and the Fox Valley have long histories of serving rural Wisconsin through hub-and-spoke networks. The far north is lake and forest country where specialty care means a long drive south, and some western residents use Twin Cities or Rochester, Minnesota providers. Wisconsin's tradition of clinic-based integrated care tends to keep billing relatively coordinated.
This procedure: An upper endoscopy, or EGD, passes a thin flexible camera through the mouth to examine the esophagus, stomach, and the first part of the small intestine. It investigates problems like persistent heartburn, swallowing difficulty, unexplained anemia, or upper abdominal pain. You receive sedation through an IV, the exam itself takes 10 to 20 minutes, and you go home the same day once the sedation wears off, needing a driver.
What Is Upper Endoscopy (EGD)?
An upper endoscopy, or EGD, passes a thin flexible camera through the mouth to examine the esophagus, stomach, and the first part of the small intestine. It investigates problems like persistent heartburn, swallowing difficulty, unexplained anemia, or upper abdominal pain. You receive sedation through an IV, the exam itself takes 10 to 20 minutes, and you go home the same day once the sedation wears off, needing a driver.
What Affects the Cost
- –The choice between a hospital outpatient department and a freestanding endoscopy center is the single biggest price lever.
- –Sedation billed by a separate anesthesia provider, especially propofol given by an anesthesiologist or CRNA, adds a significant independent charge.
- –This code is the diagnostic-only exam; if the doctor takes even one biopsy the procedure is recoded to 43239 at a higher rate plus lab fees.
- –Pre-procedure consultation visits with the gastroenterologist are billed separately from the endoscopy itself.
- –Facility fees vary more than physician fees, so the same doctor can cost very different amounts at different locations.
Questions to Ask Before Booking
- 1.Can this be scheduled at a freestanding endoscopy center rather than the hospital, and what is the facility fee at each?
- 2.Who provides the sedation, what type is used, and are they in my network?
- 3.If you take biopsies during the exam, how much does the procedure code and pathology add?
- 4.Is prior authorization required and has it been obtained?
- 5.What is the all-in estimate including physician, facility, anesthesia, and pathology?
Other featured procedures in Wisconsin
Upper Endoscopy (EGD) in other states
Upper Endoscopy (EGD) in Wisconsin: questions
Wisconsin is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 43235 is $306.75 in an office and $103.56 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Wisconsin uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $61 for the office physician line or $21 for the hospital physician line in Wisconsin. Medigap may cover that 20%. This is not the hospital facility fee.
No. $306.75 is only the physician's share. Adding Medicare's facility payment brings the total to about $1,037 in a hospital outpatient department, or about $608 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. Wisconsin ranks #19 of 51 states on the physician line (5% below the national office rate of $322.65).