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 |
|---|---|---|---|---|
| Hastings, MI | $341.58 | $64.03 – $449.84 | 474 | 2 |
| Chardon, OH | $425.14 | $425.14 – $425.14 | 477 | 1 |
| Lenexa, KS | $217.44 | $163.87 – $453.35 | 478 | 3 |
| Dalton, GA | $38.88 | $29.48 – $42.08 | 478 | 3 |
| Aibonito, PR | $344.40 | $342.84 – $405.00 | 478 | 2 |
| Cottonwood, AZ | $464.14 | $55.65 – $635.69 | 479 | 3 |
| Freeport, NY | $63.29 | $63.29 – $63.29 | 481 | 1 |
| Plano, TX | $200.40 | $5.44 – $262.25 | 483 | 6 |
| Inverness, FL | $159.64 | $159.64 – $159.64 | 483 | 1 |
| Shiprock, NM | $207.24 | $154.86 – $210.70 | 484 | 2 |
| New Windsor, NY | $344.63 | $260.95 – $357.06 | 485 | 3 |
| Winfield, IL | $168.34 | $152.17 – $172.19 | 490 | 3 |
| Hacienda Hts, CA | $59.63 | $59.63 – $59.63 | 490 | 1 |
| Laurel, MD | $94.69 | $92.05 – $102.93 | 491 | 2 |
| Fredericksbrg, VA | $91.06 | $91.06 – $91.06 | 494 | 1 |
| Festus, MO | $146.30 | $126.88 – $176.07 | 497 | 3 |
| Minden, LA | $120.85 | $104.01 – $180.10 | 497 | 2 |
| Ruston, LA | $104.50 | $104.50 – $104.50 | 501 | 1 |
| Miami Beach, FL | $158.69 | $86.60 – $585.58 | 502 | 3 |
| Goshen, IN | $158.11 | $80.07 – $166.92 | 503 | 2 |
| Sicklerville, NJ | $176.22 | $98.74 – $194.88 | 505 | 2 |
| Manitowoc, WI | $156.94 | $129.87 – $170.44 | 508 | 2 |
| Norton, OH | $187.69 | $177.64 – $199.00 | 508 | 2 |
| Wailuku, HI | $253.85 | $83.21 – $278.54 | 511 | 3 |
| Summit, WI | $192.88 | $156.63 – $231.21 | 516 | 3 |
| Boca Raton, FL | $248.44 | $248.44 – $248.44 | 518 | 1 |
| Salem, OH | $327.76 | $81.85 – $359.43 | 521 | 3 |
| Sebring, FL | $53.54 | $0.00 – $59.20 | 523 | 4 |
| Tavares, FL | $39.07 | $38.63 – $57.65 | 524 | 2 |
| Cortlandt Manor, NY | $726.63 | $726.63 – $726.63 | 526 | 1 |
| New Bern, NC | $86.54 | $62.88 – $93.08 | 528 | 3 |
| Decatur, IN | $486.70 | $486.70 – $486.70 | 529 | 1 |
| Abingdon, MD | $49.31 | $46.27 – $71.79 | 529 | 2 |
| Santa Barbara, CA | $136.34 | $87.73 – $179.83 | 532 | 6 |
| Valparaiso, IN | $104.91 | $104.74 – $105.09 | 532 | 2 |
| Gardner, MA | $493.73 | $52.14 – $648.66 | 532 | 3 |
| West Hollywood, CA | $106.75 | $36.28 – $527.17 | 537 | 5 |
| Rio Grande City, TX | $17.22 | $17.22 – $17.22 | 537 | 1 |
| Lakewood, CA | $28.28 | $14.65 – $63.53 | 538 | 3 |
| Santee, CA | $208.75 | $208.75 – $208.75 | 541 | 1 |
| Garfield Heights, OH | $388.34 | $388.34 – $388.34 | 541 | 1 |
| Crystal River, FL | $165.95 | $45.61 – $175.54 | 542 | 2 |
| Des Plaines, IL | $177.59 | $146.69 – $198.77 | 546 | 7 |
| Bolingbrook, IL | $184.22 | $158.67 – $196.97 | 547 | 3 |
| Georgetown, SC | $11.17 | $8.92 – $39.60 | 547 | 2 |
| Haymarket, VA | $304.10 | $77.34 – $655.31 | 548 | 2 |
| Vernon Rockville, CT | $170.79 | $170.79 – $170.79 | 548 | 1 |
| Bethesda, MD | $446.78 | $12.74 – $482.66 | 550 | 2 |
| Sturtevant, WI | $77.91 | $77.91 – $77.91 | 550 | 1 |
| Savannah, GA | $47.19 | $47.19 – $47.19 | 552 | 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.