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 |
|---|---|---|---|---|
| Iron Mountain, MI | $303.86 | $303.86 – $303.86 | 295 | 1 |
| West Des Moines, IA | $282.86 | $282.86 – $282.86 | 296 | 1 |
| Jamaica, NY | $175.93 | $26.82 – $455.95 | 297 | 4 |
| Hickory, NC | $159.39 | $40.73 – $196.92 | 298 | 4 |
| Clarkston, MI | $57.49 | $57.49 – $57.49 | 299 | 1 |
| Wareham, MA | $76.52 | $54.31 – $613.33 | 302 | 2 |
| Santa Monica, CA | $83.05 | $83.05 – $83.05 | 303 | 1 |
| Whiteville, NC | $93.15 | $93.15 – $93.15 | 306 | 1 |
| Stafford Springs, CT | $394.69 | $394.69 – $394.69 | 308 | 1 |
| Garden City, MI | $163.55 | $62.42 – $372.83 | 310 | 2 |
| South Hill, VA | $118.54 | $31.99 – $217.30 | 311 | 3 |
| Port Orange, FL | $114.19 | $114.09 – $116.72 | 314 | 2 |
| Las Vegas, NM | $121.21 | $121.21 – $121.21 | 314 | 1 |
| Gaithersburg, MD | $92.59 | $92.59 – $92.59 | 314 | 1 |
| Hermitage, TN | $90.43 | $90.43 – $90.43 | 317 | 1 |
| Parker, CO | $224.57 | $75.61 – $321.89 | 317 | 4 |
| Aberdeen, WA | $420.35 | $420.35 – $420.35 | 317 | 1 |
| Arlington, WA | $248.55 | $248.55 – $248.55 | 317 | 1 |
| Salina, KS | $102.26 | $92.09 – $112.75 | 319 | 2 |
| Hamilton, MT | $3.95 | $3.95 – $3.95 | 319 | 1 |
| Durango, CO | $230.44 | $230.44 – $230.44 | 321 | 1 |
| Denton, TX | $39.74 | $29.29 – $45.01 | 322 | 2 |
| Reseda, CA | $177.82 | $177.82 – $177.82 | 322 | 1 |
| Shelbyville, TN | $145.56 | $145.56 – $145.56 | 322 | 1 |
| Sylacauga, AL | $144.36 | $144.36 – $144.36 | 323 | 1 |
| North Wilkesboro, NC | $108.15 | $108.15 – $108.15 | 324 | 1 |
| Lewiston, NY | $463.25 | $463.25 – $463.25 | 327 | 1 |
| Verona, NJ | $149.10 | $149.10 – $149.10 | 328 | 1 |
| Mayfield Hts, OH | $222.93 | $109.38 – $374.58 | 329 | 3 |
| Granbury, TX | $321.25 | $99.09 – $331.06 | 331 | 2 |
| Norwood, MA | $80.34 | $52.06 – $633.42 | 331 | 3 |
| Enid, OK | $154.45 | $70.93 – $157.56 | 334 | 2 |
| Murrells Inlet, SC | $11.23 | $0.94 – $77.98 | 336 | 4 |
| Bethpage, NY | $409.55 | $382.17 – $445.56 | 337 | 3 |
| Milwaukie, OR | $123.72 | $92.51 – $135.62 | 337 | 2 |
| Ocoee, FL | $72.14 | $54.35 – $108.64 | 338 | 3 |
| Palo Alto, CA | $216.70 | $30.24 – $398.01 | 338 | 6 |
| Latham, NY | $71.68 | $57.67 – $147.81 | 341 | 2 |
| Danville, IN | $186.03 | $186.03 – $186.03 | 343 | 1 |
| Sahuarita, AZ | $228.11 | $228.11 – $228.11 | 343 | 1 |
| Smithtown, NY | $580.39 | $282.00 – $592.15 | 343 | 2 |
| Celina, TX | $175.94 | $175.94 – $175.94 | 343 | 1 |
| Towson, MD | $257.95 | $257.95 – $257.95 | 344 | 1 |
| Puerto Nuevo, PR | $291.06 | $291.06 – $291.06 | 344 | 1 |
| Homestead, FL | $53.58 | $35.80 – $54.44 | 346 | 2 |
| Medford, NJ | $122.70 | $122.70 – $122.70 | 350 | 1 |
| Ayer, MA | $74.73 | $74.73 – $74.73 | 350 | 1 |
| North Ridgeville, OH | $269.22 | $80.31 – $275.93 | 350 | 2 |
| Chapel Hill, NC | $223.24 | $100.76 – $247.82 | 353 | 2 |
| Fort Thomas, KY | $386.06 | $386.06 – $386.06 | 353 | 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.