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 |
|---|---|---|---|---|
| Chillicothe, OH | $172.75 | $66.64 – $491.33 | 3,681 | 10 |
| Salem, KY | $179.65 | $85.53 – $346.28 | 3,693 | 4 |
| Fairfield, CT | $49.40 | $0.00 – $79.40 | 3,698 | 8 |
| Wausau, WI | $109.24 | $85.43 – $298.88 | 3,703 | 8 |
| Cedar Falls, IA | $166.43 | $166.43 – $166.43 | 3,705 | 1 |
| Loxahatchee, FL | $236.44 | $30.27 – $309.93 | 3,723 | 4 |
| Abingdon, VA | $266.34 | $50.21 – $352.18 | 3,739 | 4 |
| Stamford, CT | $351.66 | $4.68 – $408.13 | 3,786 | 4 |
| Sweetwater, TN | $172.80 | $172.80 – $172.80 | 3,811 | 1 |
| Glasgow, KY | $296.41 | $89.63 – $446.48 | 3,826 | 2 |
| Arcadia, CA | $84.55 | $22.26 – $97.81 | 3,834 | 7 |
| Garden Grove, CA | $155.72 | $3.87 – $217.11 | 3,838 | 6 |
| Meridian, MS | $163.62 | $11.88 – $193.02 | 3,848 | 7 |
| Sheboygan, WI | $156.16 | $112.48 – $193.80 | 3,861 | 7 |
| Montrose, CO | $138.45 | $112.09 – $156.88 | 3,863 | 2 |
| Houston, TX | $205.54 | $40.15 – $691.13 | 3,871 | 28 |
| Hamilton, OH | $190.07 | $150.74 – $353.74 | 3,875 | 3 |
| South Windsor, CT | $112.14 | $42.68 – $233.39 | 3,889 | 4 |
| Corinth, MS | $116.11 | $56.66 – $146.02 | 3,892 | 3 |
| Albany, KY | $162.90 | $70.82 – $379.38 | 3,894 | 2 |
| Middletown, CT | $227.78 | $32.99 – $317.84 | 3,896 | 11 |
| Danville, KY | $219.13 | $57.91 – $262.70 | 3,922 | 6 |
| Oak Lawn, IL | $192.53 | $124.73 – $226.09 | 3,927 | 10 |
| Bridgeport, WV | $132.95 | $71.99 – $259.86 | 3,957 | 5 |
| Santa Rosa, CA | $119.82 | $44.10 – $307.14 | 3,958 | 11 |
| Pinehurst, NC | $130.51 | $52.90 – $170.93 | 3,980 | 7 |
| Morganton, NC | $102.20 | $50.70 – $142.38 | 3,987 | 4 |
| Falls Church, VA | $516.04 | $41.22 – $522.07 | 4,003 | 3 |
| Taylor, MI | $364.43 | $364.43 – $364.43 | 4,010 | 1 |
| Vernon, CT | $143.98 | $123.08 – $434.87 | 4,014 | 2 |
| Inglewood, CA | $138.55 | $64.43 – $157.53 | 4,021 | 5 |
| Grand Blanc, MI | $131.92 | $61.36 – $291.75 | 4,028 | 3 |
| Mcallen, TX | $209.67 | $0.00 – $272.76 | 4,042 | 14 |
| Youngstown, OH | $374.15 | $56.74 – $422.91 | 4,053 | 7 |
| Springfield, IL | $235.07 | $149.71 – $314.68 | 4,062 | 15 |
| Spartanburg, SC | $33.27 | $0.00 – $155.01 | 4,073 | 8 |
| Kissimmee, FL | $144.99 | $17.10 – $273.17 | 4,075 | 11 |
| Lakeland, FL | $66.84 | $28.79 – $163.21 | 4,078 | 9 |
| Freedom, CA | $329.72 | $87.75 – $341.29 | 4,079 | 3 |
| Eatontown, NJ | $427.12 | $248.69 – $430.61 | 4,128 | 3 |
| Buffalo, NY | $617.39 | $92.80 – $1,978 | 4,132 | 12 |
| Ventura, CA | $209.09 | $39.04 – $428.07 | 4,140 | 7 |
| Hackensack, NJ | $1,274 | $66.50 – $1,840 | 4,142 | 6 |
| Pomona, CA | $243.13 | $33.26 – $564.48 | 4,158 | 8 |
| Lafayette, IN | $405.27 | $74.25 – $597.71 | 4,163 | 9 |
| North Las Vegas, NV | $75.77 | $6.37 – $80.78 | 4,182 | 5 |
| Hialeah, FL | $77.59 | $7.02 – $621.06 | 4,190 | 15 |
| El Paso, TX | $173.94 | $22.15 – $330.21 | 4,198 | 14 |
| Columbia, MD | $98.03 | $8.17 – $141.48 | 4,224 | 8 |
| Syracuse, NY | $489.20 | $63.61 – $1,137 | 4,225 | 12 |
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.