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 |
|---|---|---|---|---|
| Martinsville, VA | $424.70 | $32.44 – $573.46 | 834 | 4 |
| Newark, OH | $301.57 | $67.15 – $421.48 | 836 | 3 |
| Gurnee, IL | $183.07 | $174.21 – $192.26 | 838 | 4 |
| Springdale, AR | $218.42 | $158.66 – $289.54 | 838 | 3 |
| Bethlehem, PA | $169.74 | $108.33 – $204.09 | 840 | 4 |
| Phila, PA | $180.26 | $95.31 – $229.55 | 843 | 3 |
| Gainesville, FL | $58.28 | $0.00 – $355.69 | 845 | 10 |
| Willow Park, TX | $184.12 | $24.76 – $187.58 | 848 | 2 |
| Cypress, TX | $332.98 | $187.46 – $337.57 | 849 | 2 |
| Sylmar, CA | $18.26 | $3.18 – $58.55 | 849 | 3 |
| Keene, NH | $199.47 | $63.48 – $216.35 | 850 | 3 |
| Whippany, NJ | $466.65 | $466.65 – $466.65 | 851 | 1 |
| Bartonsville, PA | $131.27 | $131.27 – $131.27 | 851 | 1 |
| New Port Richey, FL | $150.73 | $39.30 – $275.45 | 852 | 5 |
| Norwalk, OH | $230.44 | $85.91 – $309.02 | 859 | 4 |
| Bourbonnais, IL | $163.92 | $37.43 – $195.02 | 863 | 9 |
| Downey, CA | $103.20 | $50.46 – $199.37 | 868 | 4 |
| Arlington, VA | $282.00 | $55.44 – $343.79 | 868 | 2 |
| Rio Rancho, NM | $237.92 | $145.28 – $439.01 | 868 | 4 |
| Laurel, MS | $136.40 | $136.40 – $136.40 | 869 | 1 |
| Millburn, NJ | $89.28 | $79.43 – $92.28 | 870 | 2 |
| Woodbridge, NJ | $137.00 | $137.00 – $137.00 | 870 | 1 |
| Decatur, AL | $58.74 | $21.98 – $77.84 | 871 | 3 |
| Ithaca, NY | $801.27 | $120.31 – $820.47 | 875 | 2 |
| Melbourne, FL | $83.72 | $35.97 – $503.07 | 883 | 5 |
| Oxford, MS | $113.78 | $48.58 – $145.56 | 885 | 5 |
| Toppenish, WA | $201.24 | $201.24 – $201.24 | 885 | 1 |
| Downers Grove, IL | $193.78 | $140.16 – $235.46 | 891 | 5 |
| Sherman Oaks, CA | $103.35 | $103.35 – $103.35 | 894 | 1 |
| Crestview, FL | $15.99 | $15.99 – $15.99 | 896 | 1 |
| Franklin, MI | $58.69 | $58.69 – $58.69 | 896 | 1 |
| Richmond Hill, NY | $780.84 | $780.84 – $780.84 | 901 | 1 |
| Laurinburg, NC | $94.33 | $88.91 – $97.10 | 912 | 2 |
| Pomona, NJ | $1,350 | $48.18 – $1,796 | 913 | 2 |
| Batavia, NY | $798.02 | $798.02 – $798.02 | 913 | 1 |
| Ketchum, ID | $172.43 | $172.43 – $172.43 | 914 | 1 |
| Denville, NJ | $75.18 | $75.18 – $75.18 | 915 | 1 |
| Salisbury, NC | $79.16 | $67.86 – $234.27 | 916 | 3 |
| Dublin, OH | $205.07 | $43.94 – $368.79 | 918 | 7 |
| Camillus, NY | $388.59 | $109.91 – $483.77 | 921 | 3 |
| Rochester, MN | $144.13 | $62.52 – $719.46 | 922 | 12 |
| Glastonbury, CT | $66.05 | $37.78 – $84.38 | 924 | 4 |
| Dover, NH | $310.04 | $296.56 – $686.26 | 925 | 2 |
| Pocatello, ID | $205.93 | $115.40 – $386.41 | 925 | 6 |
| Burlington, WI | $204.36 | $204.36 – $204.36 | 930 | 1 |
| Oceanside, NY | $584.36 | $584.36 – $584.36 | 931 | 1 |
| Barnegat, NJ | $421.67 | $413.12 – $452.30 | 935 | 2 |
| Niles, IL | $189.35 | $137.81 – $223.99 | 936 | 7 |
| Monroe, MI | $231.05 | $70.10 – $349.69 | 936 | 4 |
| Porterville, CA | $66.65 | $20.31 – $102.83 | 938 | 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.