Average Medicaid Upper Endoscopy (EGD) Payments
Typical Medicaid Upper Endoscopy (EGD) reimbursement across 2,153 cities
Avg. Medicaid Paid
$251.83
Price Range
$0.00 – $1,810
Total Claims
5.9M
Cities
2153
Typical Payment Range
Typical Medicaid Upper Endoscopy (EGD) payments fall between $76.12 and $225.09 per claim (median: $127.97). The top 10% of payments exceed $381.16.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
Upper endoscopy examines the lining of the esophagus, stomach, and first part of the small intestine using a thin, flexible tube with a camera.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Ashland, WI | $416.67 | $360.56 – $585.01 | 76 | 2 |
| Broomfield, CO | $206.42 | $206.42 – $206.42 | 76 | 1 |
| Somerville, MA | $78.39 | $78.39 – $78.39 | 77 | 1 |
| Orland Park, IL | $124.30 | $97.89 – $141.15 | 77 | 2 |
| Austell, GA | $51.51 | $32.06 – $134.50 | 79 | 2 |
| Dubois, PA | $51.18 | $51.18 – $51.18 | 79 | 1 |
| Vero Beach, FL | $187.47 | $187.47 – $187.47 | 80 | 1 |
| Highland, IL | $163.03 | $163.03 – $163.03 | 80 | 1 |
| Hacienda Heights, CA | $65.16 | $55.10 – $122.11 | 80 | 2 |
| Lincoln Park, NJ | $146.71 | $146.71 – $146.71 | 80 | 1 |
| Marion, IN | $389.86 | $389.86 – $389.86 | 81 | 1 |
| Petaluma, CA | $95.35 | $71.00 – $222.67 | 81 | 2 |
| Olathe, KS | $91.84 | $91.84 – $91.84 | 81 | 1 |
| Sullivan, MO | $563.73 | $563.73 – $563.73 | 81 | 1 |
| Anaconda, MT | $85.02 | $85.02 – $85.02 | 81 | 1 |
| Suwanee, GA | $207.73 | $207.73 – $207.73 | 81 | 1 |
| Two Rivers, WI | $179.48 | $140.68 – $201.86 | 82 | 2 |
| Carlisle, PA | $169.00 | $169.00 – $169.00 | 82 | 1 |
| Saint Cloud, MN | $230.53 | $175.63 – $344.40 | 83 | 2 |
| Olympia Fields, IL | $421.49 | $68.89 – $1,153 | 83 | 2 |
| Council Bluffs, IA | $207.09 | $207.09 – $207.09 | 83 | 1 |
| Marlton, NJ | $24.13 | $0.00 – $154.08 | 83 | 2 |
| Santurce, PR | $396.58 | $396.58 – $396.58 | 84 | 1 |
| Quincy, IL | $165.39 | $155.24 – $212.11 | 84 | 2 |
| Pascagoula, MS | $123.38 | $81.61 – $172.42 | 84 | 3 |
| Fayetteville, GA | $56.21 | $56.21 – $56.21 | 84 | 1 |
| Celina, OH | $88.82 | $88.82 – $88.82 | 85 | 1 |
| Port Matilda, PA | $156.84 | $54.42 – $348.04 | 86 | 2 |
| Florence, AL | $87.71 | $67.38 – $97.36 | 87 | 2 |
| Willmar, MN | $95.06 | $72.90 – $235.37 | 88 | 2 |
| Berlin, MD | $193.37 | $42.37 – $328.31 | 89 | 2 |
| Tarpon Springs, FL | $157.51 | $157.51 – $157.51 | 89 | 1 |
| Mount Kisco, NY | $197.53 | $73.85 – $1,001 | 90 | 2 |
| Maspeth, NY | $113.21 | $113.21 – $113.21 | 90 | 1 |
| Elyria, OH | $217.42 | $55.32 – $254.66 | 91 | 2 |
| Marion, IL | $55.00 | $55.00 – $55.00 | 91 | 1 |
| Hazelwood, MO | $144.56 | $144.56 – $144.56 | 91 | 1 |
| Lawton, OK | $99.84 | $99.84 – $99.84 | 91 | 1 |
| Encinitas, CA | $293.48 | $191.31 – $334.34 | 91 | 2 |
| Canton, IL | $194.26 | $192.33 – $196.62 | 91 | 2 |
| Bayshore, NY | $61.78 | $61.78 – $61.78 | 91 | 1 |
| Orem, UT | $126.04 | $126.04 – $126.04 | 92 | 1 |
| West Valley City, UT | $68.91 | $22.93 – $138.97 | 94 | 3 |
| Warrenton, VA | $475.96 | $475.96 – $475.96 | 95 | 1 |
| Marinette, WI | $187.26 | $93.70 – $200.79 | 95 | 2 |
| Edmond, OK | $51.96 | $51.96 – $51.96 | 96 | 1 |
| Lebanon, IN | $106.12 | $106.12 – $106.12 | 96 | 1 |
| Moultrie, GA | $54.09 | $54.09 – $54.09 | 97 | 1 |
| Santa Paula, CA | $251.92 | $251.92 – $251.92 | 97 | 1 |
| Ellsworth, ME | $343.49 | $92.18 – $381.93 | 98 | 2 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 43239 | EGD w/biopsy upper GI | $253.86 | 5,956,836 | 9,455 |
| 43235 | EGD diagnostic upper GI | $254.50 | 202,728 | 958 |
| 43248 | EGD w/dilation guide wire | $140.00 | 59,963 | 186 |
| 43249 | EGD w/balloon dilation | $350.47 | 27,932 | 155 |
| 43251 | EGD w/snare removal | $247.77 | 8,994 | 30 |
| 43255 | EGD w/control bleeding | $475.08 | 7,407 | 9 |
| 43246 | EGD w/PEG tube placement | $137.82 | 3,019 | 30 |
| 43237 | EGD w/endoscopic us | $308.70 | 2,887 | 33 |
| 43250 | EGD w/tumor removal | $258.39 | 2,380 | 11 |
| 43244 | EGD w/band ligation | $253.62 | 1,697 | 25 |
| 43236 | EGD w/submucosal injection | $37.02 | 1,037 | 6 |
| 43245 | EGD w/dilation stricture | $91.88 | 1,020 | 10 |
| 43247 | EGD w/foreign body removal | $93.65 | 915 | 11 |
| 43252 | EGD w/optical endomicroscopy | $166.89 | 722 | 10 |
| 43254 | EGD w/endo mucosal resection | $164.97 | 472 | 2 |
| 43242 | EGD w/us guided inj/asp | $234.58 | 258 | 9 |
| 43253 | EGD w/injection sclerosis | $179.99 | 161 | 4 |
| 43238 | EGD w/us guided needle bx | $618.60 | 13 | 1 |
| 43241 | EGD w/tube/catheter | $91.14 | 13 | 1 |
| 43240 | EGD w/drainage pseudocyst | — | — | — |
| 43243 | EGD w/injection varices | — | — | — |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.