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 |
|---|---|---|---|---|
| Florham Park, NJ | $491.76 | $491.76 – $491.76 | 2,060 | 1 |
| Kokomo, IN | $133.93 | $116.58 – $157.81 | 2,060 | 2 |
| Marquette, MI | $183.54 | $70.42 – $325.21 | 2,061 | 2 |
| Woodland, CA | $80.57 | $33.42 – $238.14 | 2,063 | 5 |
| Gallipolis, OH | $378.25 | $241.74 – $564.85 | 2,064 | 2 |
| Pikesville, MD | $34.49 | $34.49 – $34.49 | 2,072 | 1 |
| Dickson, TN | $178.85 | $144.73 – $179.11 | 2,076 | 2 |
| Fond Du Lac, WI | $158.27 | $128.13 – $202.53 | 2,076 | 5 |
| Salinas, PR | $255.80 | $255.80 – $255.80 | 2,077 | 1 |
| Bay City, MI | $125.79 | $48.24 – $268.62 | 2,083 | 2 |
| Chaska, MN | $143.54 | $79.36 – $239.00 | 2,083 | 3 |
| Fargo, ND | $293.94 | $121.81 – $971.41 | 2,091 | 8 |
| Fort Collins, CO | $197.16 | $98.24 – $217.70 | 2,092 | 8 |
| Northridge, CA | $116.86 | $36.91 – $134.42 | 2,096 | 4 |
| Grosse Pointe, MI | $361.19 | $361.19 – $361.19 | 2,102 | 1 |
| Zephyrhills, FL | $153.99 | $7.42 – $167.09 | 2,109 | 5 |
| Murfreesboro, TN | $115.52 | $43.13 – $198.46 | 2,110 | 5 |
| White Plains, NY | $568.60 | $83.85 – $642.79 | 2,113 | 5 |
| Longmont, CO | $185.08 | $130.07 – $248.11 | 2,120 | 10 |
| Cooperstown, NY | $675.87 | $43.89 – $752.07 | 2,129 | 5 |
| Marysville, MI | $56.39 | $56.39 – $56.39 | 2,130 | 1 |
| Madison, MS | $135.55 | $135.55 – $135.55 | 2,131 | 1 |
| Port Jefferson, NY | $789.30 | $119.12 – $868.47 | 2,137 | 3 |
| Easton, MD | $38.00 | $36.48 – $82.86 | 2,142 | 3 |
| Warren, MI | $180.52 | $35.62 – $351.93 | 2,144 | 6 |
| Biddeford, ME | $309.51 | $59.27 – $333.43 | 2,144 | 3 |
| Topeka, KS | $143.53 | $105.37 – $218.58 | 2,148 | 6 |
| Albemarle, NC | $92.90 | $92.90 – $92.90 | 2,150 | 1 |
| Summersville, WV | $258.51 | $66.95 – $360.05 | 2,151 | 6 |
| Mobile, AL | $286.76 | $18.49 – $429.56 | 2,152 | 13 |
| Southaven, MS | $86.67 | $76.56 – $102.51 | 2,154 | 2 |
| West Bloomfield, MI | $87.51 | $56.72 – $319.77 | 2,170 | 2 |
| Waterloo, IA | $194.39 | $96.50 – $239.28 | 2,175 | 6 |
| Willingboro, NJ | $514.74 | $74.81 – $1,436 | 2,177 | 6 |
| Fallbrook, CA | $187.08 | $185.27 – $272.99 | 2,178 | 2 |
| Davenport, IA | $206.12 | $118.53 – $254.26 | 2,180 | 4 |
| La Mesa, CA | $197.56 | $122.71 – $307.42 | 2,180 | 6 |
| West Chester, OH | $221.00 | $34.84 – $362.90 | 2,181 | 6 |
| Buckhannon, WV | $205.18 | $73.47 – $282.58 | 2,181 | 3 |
| Petersburg, VA | $319.31 | $109.92 – $480.05 | 2,219 | 3 |
| Rapid City, SD | $152.27 | $87.07 – $269.80 | 2,230 | 5 |
| Virginia Beach, VA | $524.30 | $133.66 – $530.05 | 2,232 | 3 |
| Fishkill, NY | $470.87 | $442.38 – $471.04 | 2,236 | 2 |
| Rancho Cucamonga, CA | $181.16 | $103.48 – $381.07 | 2,238 | 6 |
| Janesville, WI | $175.40 | $155.49 – $180.85 | 2,242 | 3 |
| Rock Hill, SC | $124.01 | $0.00 – $129.38 | 2,247 | 6 |
| Shelbyville, KY | $85.33 | $85.33 – $85.33 | 2,252 | 1 |
| Port Huron, MI | $315.78 | $66.78 – $370.51 | 2,254 | 3 |
| Chesapeake, VA | $425.50 | $68.65 – $457.58 | 2,255 | 2 |
| Alma, MI | $113.02 | $69.07 – $351.47 | 2,262 | 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.