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 |
|---|---|---|---|---|
| Stoneham, MA | $53.56 | $52.82 – $57.37 | 152 | 4 |
| Belmont, NC | $179.79 | $179.79 – $179.79 | 153 | 1 |
| Douglaston, NY | $134.08 | $132.48 – $141.89 | 153 | 2 |
| Rockaway Park, NY | $189.36 | $189.36 – $189.36 | 154 | 1 |
| Geneseo, NY | $115.49 | $115.49 – $115.49 | 154 | 1 |
| Edwardsville, PA | $86.78 | $86.78 – $86.78 | 155 | 1 |
| Davie, FL | $252.93 | $252.93 – $252.93 | 157 | 1 |
| Salem, NJ | $356.48 | $356.48 – $356.48 | 157 | 1 |
| Fort Defiance, AZ | $236.92 | $114.95 – $246.95 | 158 | 2 |
| Greenville, TX | $52.33 | $52.33 – $52.33 | 161 | 1 |
| Salisbury, MD | $106.95 | $74.64 – $466.54 | 162 | 3 |
| Boone, NC | $71.95 | $71.95 – $71.95 | 162 | 1 |
| Dover, OH | $236.61 | $83.65 – $281.69 | 162 | 3 |
| Brewster, NY | $130.45 | $130.45 – $130.45 | 162 | 1 |
| Clanton, AL | $155.40 | $155.40 – $155.40 | 163 | 1 |
| Madison, IN | $276.87 | $276.87 – $276.87 | 163 | 1 |
| Valley, AL | $111.57 | $109.98 – $131.73 | 164 | 2 |
| Winchester, MA | $1,033 | $1,033 – $1,033 | 165 | 1 |
| Sycamore, IL | $173.75 | $173.75 – $173.75 | 165 | 1 |
| St Albans, VT | $46.38 | $46.38 – $46.38 | 166 | 1 |
| Fishers, IN | $237.21 | $75.39 – $623.59 | 166 | 2 |
| Riverdale, MD | $157.42 | $89.56 – $162.68 | 167 | 2 |
| Altamonte Springs, FL | $228.83 | $188.62 – $284.54 | 167 | 2 |
| Aguada, PR | $322.02 | $322.02 – $322.02 | 167 | 1 |
| Glen Ridge, NJ | $206.78 | $206.78 – $206.78 | 167 | 1 |
| Santa Cruz, CA | $47.81 | $19.05 – $123.41 | 168 | 3 |
| Winnfield, LA | $170.27 | $170.27 – $170.27 | 168 | 1 |
| Fort Lauderdale, FL | $143.86 | $61.84 – $221.05 | 169 | 3 |
| Avon, CO | $135.26 | $135.26 – $135.26 | 169 | 1 |
| Seaford, VA | $430.64 | $430.64 – $430.64 | 169 | 1 |
| Carmel, NY | $524.29 | $524.29 – $524.29 | 170 | 1 |
| Northampton, MA | $473.94 | $473.94 – $473.94 | 170 | 1 |
| Manning, SC | $38.82 | $28.16 – $70.30 | 170 | 2 |
| Port Jervis, NY | $992.38 | $992.38 – $992.38 | 170 | 1 |
| Franklin, NC | $104.49 | $104.49 – $104.49 | 171 | 1 |
| Elkhorn, WI | $230.72 | $172.69 – $241.61 | 171 | 2 |
| Elkhart, IN | $180.95 | $30.26 – $290.79 | 172 | 3 |
| Jber, AK | $400.97 | $400.97 – $400.97 | 172 | 1 |
| Jupiter, FL | $252.26 | $252.26 – $252.26 | 173 | 1 |
| Valley Stream, NY | $190.93 | $124.68 – $458.10 | 173 | 3 |
| Mullica Hill, NJ | $1,057 | $1,057 – $1,057 | 173 | 1 |
| Mcalester, OK | $191.85 | $191.85 – $191.85 | 174 | 1 |
| Menomonee Falls, WI | $156.13 | $105.21 – $176.83 | 174 | 4 |
| Avon, IN | $117.48 | $117.48 – $117.48 | 174 | 1 |
| Rutherfordton, NC | $167.18 | $167.18 – $167.18 | 174 | 1 |
| Riverdale, GA | $336.77 | $336.77 – $336.77 | 174 | 1 |
| Corte Madera, CA | $38.75 | $24.36 – $234.23 | 175 | 2 |
| Duluth, GA | $11.50 | $3.47 – $120.64 | 175 | 2 |
| Cape Girardeau, MO | $217.07 | $129.79 – $573.29 | 176 | 3 |
| Ocean, NJ | $73.23 | $73.23 – $73.23 | 176 | 1 |
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.