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 |
|---|---|---|---|---|
| Placentia, CA | $16.54 | $16.54 – $16.54 | 940 | 1 |
| Toms River, NJ | $299.28 | $65.64 – $2,161 | 941 | 7 |
| Jackson, OH | $206.37 | $206.37 – $206.37 | 942 | 1 |
| Waterville, ME | $71.44 | $68.50 – $276.74 | 948 | 3 |
| Waukesha, WI | $154.14 | $152.96 – $172.94 | 949 | 2 |
| Ridgewood, NJ | $1,045 | $77.57 – $1,617 | 949 | 3 |
| Beachwood, OH | $184.10 | $89.03 – $334.57 | 953 | 2 |
| Scottsbluff, NE | $131.85 | $124.12 – $238.12 | 959 | 2 |
| Fort Dodge, IA | $297.38 | $297.38 – $297.38 | 963 | 1 |
| Tuscaloosa, AL | $70.58 | $0.00 – $88.93 | 965 | 3 |
| French Camp, CA | $192.63 | $192.63 – $192.63 | 967 | 1 |
| Turnersville, NJ | $102.03 | $97.32 – $105.23 | 969 | 4 |
| Greenbrae, CA | $113.86 | $96.94 – $335.65 | 970 | 3 |
| Laguna Hills, CA | $93.12 | $67.48 – $99.00 | 970 | 2 |
| Norwood, OH | $229.21 | $229.21 – $229.21 | 971 | 1 |
| Beaumont, TX | $199.40 | $58.09 – $201.46 | 973 | 2 |
| Laguna Woods, CA | $0.38 | $0.38 – $0.38 | 976 | 1 |
| Westfield, MA | $569.85 | $43.98 – $874.48 | 976 | 2 |
| Braintree, MA | $60.32 | $57.99 – $60.38 | 976 | 2 |
| Concord, CA | $418.29 | $234.34 – $469.83 | 979 | 4 |
| Eagan, MN | $108.66 | $104.23 – $277.76 | 979 | 2 |
| Altoona, PA | $109.96 | $74.15 – $123.75 | 983 | 7 |
| Des Moines, IA | $341.75 | $313.39 – $363.79 | 990 | 5 |
| Edgewater, NJ | $147.37 | $147.37 – $147.37 | 991 | 1 |
| Palmer, AK | $412.22 | $376.12 – $568.66 | 992 | 2 |
| Geneva, IL | $180.77 | $159.01 – $228.00 | 993 | 6 |
| Davenport, FL | $53.81 | $29.79 – $233.59 | 998 | 3 |
| San German, PR | $223.98 | $25.00 – $326.90 | 999 | 4 |
| Martins Ferry, OH | $136.50 | $133.79 – $204.99 | 1,000 | 2 |
| Morton Grove, IL | $158.58 | $158.58 – $158.58 | 1,004 | 1 |
| Layton, UT | $71.16 | $6.42 – $164.22 | 1,008 | 3 |
| Wayne, NJ | $273.48 | $181.57 – $622.62 | 1,013 | 5 |
| Brawley, CA | $133.91 | $117.04 – $279.40 | 1,013 | 4 |
| Ontario, OH | $282.94 | $223.86 – $373.11 | 1,013 | 2 |
| Wilson, NC | $154.50 | $31.39 – $160.43 | 1,017 | 3 |
| Tualatin, OR | $361.71 | $361.71 – $361.71 | 1,019 | 1 |
| Carmel, IN | $87.10 | $78.38 – $283.26 | 1,021 | 4 |
| Park Ridge, IL | $310.04 | $186.42 – $394.08 | 1,021 | 6 |
| Lancaster, OH | $428.38 | $63.59 – $464.60 | 1,023 | 5 |
| Prince Frederick, MD | $77.38 | $72.32 – $223.58 | 1,025 | 4 |
| Peoria, IL | $172.85 | $74.57 – $225.23 | 1,027 | 8 |
| Riverton, UT | $67.26 | $11.75 – $154.73 | 1,034 | 6 |
| Waldorf, MD | $105.27 | $66.01 – $107.00 | 1,051 | 3 |
| Warrensville Heights, OH | $335.04 | $85.16 – $469.39 | 1,051 | 3 |
| Bala Cynwyd, PA | $180.23 | $67.93 – $182.24 | 1,052 | 3 |
| Bartlesville, OK | $176.05 | $176.05 – $176.05 | 1,055 | 1 |
| Naples, FL | $129.25 | $19.43 – $207.44 | 1,057 | 5 |
| Liberty Township, OH | $264.73 | $264.73 – $264.73 | 1,058 | 1 |
| Tinley Park, IL | $185.46 | $180.50 – $280.87 | 1,058 | 3 |
| Manhasset, NY | $450.39 | $188.42 – $464.19 | 1,059 | 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.