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 |
|---|---|---|---|---|
| Jefferson City, MO | $158.59 | $158.59 – $158.59 | 98 | 1 |
| Clearlake, CA | $141.52 | $86.83 – $184.51 | 98 | 3 |
| Washington, MO | $223.12 | $26.20 – $302.46 | 98 | 4 |
| Grants Pass, OR | $97.43 | $70.98 – $233.29 | 99 | 4 |
| Mount Airy, NC | $80.08 | $80.08 – $80.08 | 99 | 1 |
| Danville, CA | $578.97 | $578.97 – $578.97 | 99 | 1 |
| West Seneca, NY | $529.68 | $529.68 – $529.68 | 100 | 1 |
| Lake Wales, FL | $121.13 | $57.15 – $416.15 | 101 | 2 |
| Hillsboro, OR | $266.74 | $266.74 – $266.74 | 101 | 1 |
| West Burlington, IA | $153.91 | $55.46 – $168.46 | 101 | 2 |
| Loris, SC | $0.00 | $0.00 – $0.00 | 101 | 1 |
| Bullhead City, AZ | $268.98 | $268.98 – $268.98 | 102 | 1 |
| Sugar Land, TX | $49.53 | $38.07 – $64.64 | 102 | 2 |
| Conyers, GA | $30.79 | $30.79 – $30.79 | 102 | 1 |
| Skokie, IL | $113.45 | $112.00 – $115.50 | 104 | 2 |
| Vega Baja, PR | $28.31 | $28.31 – $28.31 | 105 | 1 |
| Prosser, WA | $855.01 | $855.01 – $855.01 | 105 | 1 |
| Deming, NM | $314.36 | $113.08 – $684.29 | 105 | 2 |
| Meadville, PA | $65.00 | $65.00 – $65.00 | 106 | 1 |
| Elmwood Park, IL | $201.95 | $177.17 – $242.84 | 106 | 2 |
| Gardena, CA | $73.11 | $58.34 – $89.61 | 108 | 2 |
| Mount Vernon, NY | $154.83 | $154.83 – $154.83 | 108 | 1 |
| Holland, MI | $309.46 | $309.46 – $309.46 | 108 | 1 |
| Webster, TX | $216.95 | $216.95 – $216.95 | 109 | 1 |
| Roanoke, IN | $79.72 | $79.72 – $79.72 | 109 | 1 |
| Brea, CA | $61.99 | $61.99 – $61.99 | 109 | 1 |
| Mansfield, TX | $118.12 | $118.12 – $118.12 | 111 | 1 |
| Eufaula, OK | $136.33 | $136.33 – $136.33 | 111 | 1 |
| Fort Kent, ME | $251.89 | $251.89 – $251.89 | 112 | 1 |
| Westport, CT | $176.66 | $176.66 – $176.66 | 112 | 1 |
| Lexington, TN | $417.39 | $417.39 – $417.39 | 113 | 1 |
| Louisburg, NC | $46.02 | $46.02 – $46.02 | 113 | 1 |
| Washington, NC | $40.82 | $40.82 – $40.82 | 115 | 1 |
| Trevose, PA | $56.78 | $56.78 – $56.78 | 115 | 1 |
| New City, NY | $363.97 | $332.51 – $410.68 | 116 | 4 |
| Arlington Heights, IL | $87.10 | $51.55 – $98.29 | 117 | 2 |
| Portales, NM | $412.94 | $412.94 – $412.94 | 117 | 1 |
| Guilford, CT | $140.11 | $140.11 – $140.11 | 117 | 1 |
| North Adams, MA | $44.85 | $44.85 – $44.85 | 117 | 1 |
| Key West, FL | $190.58 | $190.58 – $190.58 | 118 | 1 |
| Lake Jackson, TX | $47.99 | $47.99 – $47.99 | 118 | 1 |
| Cleveland, MS | $26.00 | $19.82 – $54.58 | 118 | 2 |
| Tyler, TX | $110.02 | $34.80 – $220.75 | 120 | 4 |
| North Little Rock, AR | $114.04 | $109.80 – $123.61 | 120 | 3 |
| Harbor City, CA | $16.50 | $16.50 – $16.50 | 121 | 1 |
| Booneville, MS | $195.88 | $195.88 – $195.88 | 121 | 1 |
| Chickasha, OK | $263.25 | $263.25 – $263.25 | 122 | 1 |
| Forest City, NC | $51.84 | $51.84 – $51.84 | 122 | 1 |
| Chester, PA | $126.68 | $126.32 – $128.13 | 122 | 2 |
| Lutherville, MD | $142.83 | $134.34 – $214.65 | 123 | 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.