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 |
|---|---|---|---|---|
| Leesburg, VA | $83.89 | $62.97 – $414.74 | 1,208 | 7 |
| Supply, NC | $63.82 | $50.77 – $78.10 | 1,208 | 3 |
| Ansonia, CT | $56.25 | $54.76 – $65.53 | 1,209 | 3 |
| Carson City, NV | $142.31 | $56.05 – $147.69 | 1,210 | 4 |
| Bryan, OH | $236.80 | $123.39 – $383.71 | 1,210 | 4 |
| Addison, IL | $160.58 | $160.58 – $160.58 | 1,211 | 1 |
| Caguas, PR | $186.33 | $84.44 – $388.80 | 1,215 | 7 |
| Auburn, NY | $740.73 | $159.11 – $811.76 | 1,217 | 3 |
| Greenfield, MA | $91.61 | $38.26 – $799.40 | 1,220 | 3 |
| Novi, MI | $317.62 | $317.62 – $317.62 | 1,222 | 1 |
| Glens Falls, NY | $346.81 | $84.07 – $398.65 | 1,222 | 5 |
| San Mateo, CA | $36.43 | $27.88 – $84.11 | 1,229 | 2 |
| Marion, OH | $297.03 | $101.07 – $376.07 | 1,234 | 6 |
| Prospect, CT | $105.50 | $64.70 – $111.44 | 1,235 | 2 |
| Lawrence, MA | $229.19 | $60.32 – $232.81 | 1,239 | 2 |
| Iowa City, IA | $110.21 | $57.76 – $253.23 | 1,241 | 11 |
| Port St Lucie, FL | $88.57 | $77.04 – $306.04 | 1,244 | 4 |
| Medford, MA | $719.20 | $185.10 – $725.26 | 1,249 | 2 |
| Fountain Hill, PA | $103.76 | $49.53 – $165.23 | 1,249 | 12 |
| Portsmouth, VA | $410.46 | $410.46 – $410.46 | 1,250 | 1 |
| Maywood, IL | $143.45 | $72.69 – $222.20 | 1,251 | 11 |
| Cadillac, MI | $133.23 | $80.26 – $281.41 | 1,257 | 2 |
| Berkeley, CA | $49.07 | $17.22 – $402.04 | 1,261 | 5 |
| Rosemead, CA | $114.26 | $89.31 – $160.29 | 1,263 | 2 |
| Union Gap, WA | $47.81 | $47.81 – $47.81 | 1,267 | 1 |
| Monroe, NC | $108.15 | $34.15 – $145.17 | 1,271 | 3 |
| Woodland Hills, CA | $77.66 | $0.00 – $134.26 | 1,272 | 3 |
| Westerville, OH | $297.49 | $80.28 – $350.90 | 1,276 | 7 |
| New Bedford, MA | $743.07 | $48.88 – $750.77 | 1,277 | 2 |
| Gloversville, NY | $290.74 | $111.14 – $345.58 | 1,283 | 4 |
| Grafton, WI | $183.21 | $183.21 – $183.21 | 1,284 | 1 |
| North Charleston, SC | $111.16 | $109.27 – $111.31 | 1,287 | 2 |
| East Greenwich, RI | $172.94 | $165.19 – $176.20 | 1,288 | 3 |
| Bedford, IN | $406.54 | $406.54 – $406.54 | 1,289 | 1 |
| Olney, MD | $167.00 | $61.06 – $183.70 | 1,292 | 2 |
| Coos Bay, OR | $214.98 | $214.98 – $214.98 | 1,297 | 1 |
| Lawrenceburg, IN | $74.34 | $73.92 – $85.77 | 1,299 | 2 |
| Canandaigua, NY | $476.95 | $111.77 – $693.28 | 1,301 | 2 |
| Fuquay Varina, NC | $107.47 | $107.47 – $107.47 | 1,301 | 1 |
| Napa, CA | $50.80 | $48.64 – $78.03 | 1,306 | 2 |
| Fowler, CA | $18.18 | $18.18 – $18.18 | 1,306 | 1 |
| Darby, PA | $633.00 | $552.56 – $1,004 | 1,307 | 4 |
| Corning, NY | $401.65 | $103.85 – $538.82 | 1,316 | 2 |
| Goodyear, AZ | $354.64 | $74.58 – $401.27 | 1,324 | 2 |
| Parkersburg, WV | $91.06 | $74.13 – $135.94 | 1,325 | 3 |
| Mc Lean, VA | $183.48 | $183.48 – $183.48 | 1,337 | 1 |
| Wayne, MI | $345.67 | $345.67 – $345.67 | 1,337 | 1 |
| Hagerstown, MD | $104.81 | $69.78 – $219.97 | 1,346 | 9 |
| Nashua, NH | $231.67 | $47.63 – $517.75 | 1,346 | 5 |
| Farmville, VA | $177.59 | $60.82 – $338.78 | 1,352 | 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.