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 |
|---|---|---|---|---|
| Overland Park, KS | $73.53 | $67.77 – $155.83 | 214 | 2 |
| Rosedale, MD | $95.54 | $95.54 – $95.54 | 214 | 1 |
| Moorestown, NJ | $105.26 | $103.14 – $135.68 | 215 | 2 |
| Livingston, TN | $143.84 | $143.84 – $143.84 | 215 | 1 |
| Brattleboro, VT | $59.34 | $59.34 – $59.34 | 216 | 1 |
| Reidsville, NC | $169.79 | $51.78 – $177.85 | 219 | 2 |
| Galveston, TX | $133.70 | $22.59 – $875.43 | 219 | 3 |
| Laquinta, CA | $181.22 | $181.22 – $181.22 | 219 | 1 |
| Norton, VA | $342.28 | $342.28 – $342.28 | 220 | 1 |
| Highlands Ranch, CO | $178.64 | $178.64 – $178.64 | 220 | 1 |
| Stillwater, OK | $258.28 | $258.28 – $258.28 | 220 | 1 |
| Rock Hill, NY | $206.55 | $206.55 – $206.55 | 220 | 1 |
| Marion, KY | $441.73 | $373.48 – $459.77 | 220 | 2 |
| Mount Pleasant, PA | $96.18 | $96.18 – $96.18 | 220 | 1 |
| Lihue, HI | $283.59 | $173.37 – $348.60 | 221 | 2 |
| Springhill, LA | $166.54 | $166.54 – $166.54 | 221 | 1 |
| Mt Pleasant, MI | $192.99 | $192.99 – $192.99 | 224 | 1 |
| Riverside, RI | $161.77 | $161.77 – $161.77 | 224 | 1 |
| Carol Stream, IL | $185.82 | $184.30 – $204.46 | 225 | 2 |
| Lake Mary, FL | $108.71 | $108.71 – $108.71 | 226 | 1 |
| Coeur D Alene, ID | $118.34 | $93.71 – $143.23 | 227 | 6 |
| Alpharetta, GA | $289.10 | $289.10 – $289.10 | 228 | 1 |
| Ville Platte, LA | $174.90 | $174.90 – $174.90 | 229 | 1 |
| Wytheville, VA | $428.78 | $428.78 – $428.78 | 229 | 1 |
| Buffalo Grove, IL | $232.21 | $232.21 – $232.21 | 229 | 1 |
| Pasco, WA | $369.23 | $52.46 – $438.31 | 229 | 2 |
| Ronceverte, WV | $275.38 | $65.46 – $290.03 | 230 | 2 |
| Surprise, AZ | $221.42 | $221.42 – $221.42 | 231 | 1 |
| Clarkston, WA | $379.18 | $39.63 – $752.38 | 233 | 2 |
| Irving, TX | $146.16 | $146.16 – $146.16 | 235 | 1 |
| Brooksville, FL | $147.37 | $1.94 – $185.82 | 235 | 4 |
| Lemoyne, PA | $221.60 | $221.60 – $221.60 | 237 | 1 |
| Covina, CA | $4.88 | $2.48 – $38.41 | 239 | 2 |
| Atoka, TN | $107.28 | $107.28 – $107.28 | 239 | 1 |
| Soldotna, AK | $732.74 | $732.74 – $732.74 | 240 | 1 |
| Tomball, TX | $57.20 | $57.20 – $57.20 | 240 | 1 |
| Clinton, MO | $220.44 | $220.44 – $220.44 | 240 | 1 |
| Chelsea, MI | $328.55 | $328.55 – $328.55 | 241 | 1 |
| Rutherford, NJ | $199.93 | $199.93 – $199.93 | 242 | 1 |
| South Portland, ME | $63.11 | $63.11 – $63.11 | 243 | 1 |
| Edina, MN | $131.85 | $71.02 – $494.20 | 244 | 3 |
| East Brunswick, NJ | $142.08 | $139.17 – $198.36 | 244 | 2 |
| Canon City, CO | $154.06 | $154.00 – $155.07 | 244 | 2 |
| Fayetteville, NY | $446.74 | $446.74 – $446.74 | 245 | 1 |
| Manorville, NY | $368.83 | $368.83 – $368.83 | 245 | 1 |
| Newbury Park, CA | $360.65 | $360.65 – $360.65 | 246 | 1 |
| Wilmington, OH | $402.05 | $402.05 – $402.05 | 247 | 1 |
| Rolla, MO | $255.37 | $231.30 – $469.17 | 247 | 2 |
| Greenville, MS | $119.43 | $51.98 – $185.26 | 247 | 2 |
| Mountain View, CA | $101.31 | $22.65 – $246.85 | 248 | 3 |
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.