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 |
|---|---|---|---|---|
| Pulaski, VA | $369.72 | $369.72 – $369.72 | 552 | 1 |
| Patchogue, NY | $686.58 | $106.88 – $699.44 | 553 | 2 |
| Centralia, WA | $333.10 | $53.74 – $353.13 | 553 | 2 |
| New Rochelle, NY | $668.23 | $668.23 – $668.23 | 554 | 1 |
| Elmhurst, IL | $180.09 | $127.95 – $222.90 | 557 | 3 |
| Mequon, WI | $159.50 | $125.04 – $196.28 | 557 | 5 |
| Torrance, CA | $117.43 | $0.00 – $871.02 | 559 | 6 |
| La Junta, CO | $369.64 | $369.64 – $369.64 | 560 | 1 |
| Merrillville, IN | $208.51 | $47.20 – $566.00 | 561 | 5 |
| Austin, TX | $98.86 | $46.60 – $494.11 | 562 | 6 |
| Bossier City, LA | $103.73 | $51.39 – $108.99 | 563 | 3 |
| Trenton, NJ | $921.15 | $112.25 – $1,955 | 563 | 3 |
| Cedar Park, TX | $207.55 | $207.55 – $207.55 | 564 | 1 |
| Avon, OH | $323.29 | $323.29 – $323.29 | 565 | 1 |
| Antioch, CA | $312.19 | $91.72 – $572.57 | 565 | 3 |
| Suffern, NY | $712.03 | $131.02 – $740.97 | 569 | 2 |
| Hendersonville, TN | $111.77 | $28.86 – $123.49 | 570 | 3 |
| Huntington, NY | $319.06 | $0.00 – $651.10 | 570 | 6 |
| La Jolla, CA | $140.47 | $78.88 – $268.21 | 570 | 6 |
| Rio Piedras, PR | $308.36 | $308.36 – $308.36 | 570 | 1 |
| Bardstown, KY | $220.15 | $52.23 – $313.57 | 571 | 5 |
| Saint Joseph, MO | $127.22 | $90.24 – $153.07 | 572 | 4 |
| Silver City, NM | $479.75 | $98.52 – $487.92 | 572 | 2 |
| Minot, ND | $352.69 | $352.69 – $352.69 | 575 | 1 |
| Frederick, MD | $166.37 | $105.11 – $247.40 | 576 | 2 |
| Glen Allen, VA | $69.04 | $69.04 – $69.04 | 583 | 1 |
| Indpls, IN | $836.37 | $836.37 – $836.37 | 585 | 1 |
| Montclair, CA | $20.34 | $20.34 – $20.34 | 588 | 1 |
| Riverside, IL | $175.89 | $174.41 – $176.68 | 588 | 2 |
| Schenectady, NY | $582.15 | $582.15 – $582.15 | 589 | 1 |
| Plainview, NY | $567.07 | $567.07 – $567.07 | 590 | 1 |
| Avenel, NJ | $99.98 | $99.98 – $99.98 | 593 | 1 |
| Big Stone Gap, VA | $420.05 | $420.05 – $420.05 | 594 | 1 |
| Florence, MA | $51.17 | $45.29 – $56.65 | 594 | 6 |
| Presque Isle, ME | $253.36 | $253.36 – $253.36 | 596 | 1 |
| Plymouth, MA | $793.74 | $55.28 – $851.16 | 596 | 2 |
| Potsdam, NY | $631.82 | $96.05 – $654.23 | 598 | 2 |
| Stuart, FL | $40.75 | $40.75 – $40.75 | 599 | 1 |
| Baldwin Park, CA | $449.15 | $159.83 – $748.99 | 599 | 3 |
| Milford, CT | $397.15 | $354.51 – $403.89 | 601 | 2 |
| Hollywood, CA | $14.47 | $14.47 – $14.47 | 605 | 1 |
| Bismarck, ND | $217.93 | $204.83 – $268.47 | 607 | 2 |
| Bayside, NY | $200.36 | $95.71 – $238.46 | 607 | 2 |
| Bel Air, MD | $130.35 | $72.55 – $145.77 | 608 | 2 |
| Orangeburg, SC | $4.19 | $3.02 – $62.30 | 608 | 2 |
| Wilton, CT | $170.82 | $55.57 – $328.07 | 610 | 2 |
| Huntersville, NC | $84.32 | $66.91 – $229.59 | 612 | 5 |
| Bisbee, AZ | $441.01 | $441.01 – $441.01 | 616 | 1 |
| Lake Worth, FL | $158.52 | $39.98 – $205.32 | 617 | 5 |
| Caribou, ME | $28.26 | $27.17 – $59.31 | 618 | 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.