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 |
|---|---|---|---|---|
| Montgomery, OH | $192.39 | $85.86 – $377.02 | 4,989 | 9 |
| Hanford, CA | $28.26 | $5.15 – $45.03 | 4,999 | 5 |
| Oceanside, CA | $167.54 | $160.44 – $197.75 | 5,005 | 9 |
| Winston Salem, NC | $223.81 | $51.15 – $274.90 | 5,044 | 14 |
| Peoria, AZ | $212.07 | $77.59 – $276.60 | 5,060 | 9 |
| Kennewick, WA | $159.25 | $43.54 – $269.42 | 5,083 | 3 |
| Mt Sterling, KY | $163.85 | $76.10 – $244.55 | 5,109 | 3 |
| Fairfax, VA | $416.83 | $20.90 – $503.24 | 5,147 | 18 |
| Yakima, WA | $188.11 | $45.92 – $325.08 | 5,191 | 8 |
| Herrin, IL | $163.20 | $161.64 – $164.49 | 5,201 | 2 |
| Traverse City, MI | $138.70 | $56.97 – $287.15 | 5,215 | 6 |
| Billings, MT | $64.36 | $15.17 – $93.82 | 5,227 | 4 |
| Mount Vernon, WA | $231.43 | $43.07 – $306.14 | 5,248 | 5 |
| Renton, WA | $237.00 | $40.45 – $294.65 | 5,261 | 9 |
| Farmington Hills, MI | $155.10 | $48.09 – $336.32 | 5,269 | 7 |
| Marshall, MI | $137.98 | $45.88 – $245.63 | 5,279 | 2 |
| Medford, OR | $208.47 | $72.69 – $269.19 | 5,379 | 6 |
| Worcester, MA | $349.86 | $35.31 – $989.90 | 5,421 | 25 |
| High Point, NC | $143.25 | $61.60 – $198.70 | 5,423 | 9 |
| Lansing, MI | $280.38 | $61.83 – $312.99 | 5,431 | 6 |
| Fresh Meadows, NY | $468.43 | $120.91 – $495.13 | 5,464 | 4 |
| Williamsville, NY | $214.80 | $76.24 – $546.02 | 5,472 | 18 |
| Manchester, CT | $355.91 | $41.97 – $426.81 | 5,472 | 4 |
| Springfield, OH | $206.85 | $70.30 – $371.98 | 5,486 | 9 |
| Florence, KY | $225.81 | $76.00 – $432.94 | 5,518 | 10 |
| Simi Valley, CA | $117.84 | $34.72 – $308.07 | 5,539 | 7 |
| Egg Harbor Township, NJ | $350.17 | $183.03 – $453.50 | 5,597 | 6 |
| Old Bridge, NJ | $409.91 | $100.68 – $1,345 | 5,651 | 3 |
| Paramount, CA | $110.43 | $97.18 – $114.64 | 5,653 | 2 |
| New Albany, IN | $216.37 | $48.64 – $931.07 | 5,666 | 10 |
| Burton, MI | $157.03 | $138.85 – $157.38 | 5,703 | 2 |
| Bogalusa, LA | $156.12 | $156.12 – $156.12 | 5,722 | 1 |
| El Centro, CA | $115.52 | $47.88 – $175.99 | 5,748 | 4 |
| Coronado, CA | $211.28 | $211.28 – $211.28 | 5,751 | 1 |
| Morristown, NJ | $1,046 | $115.60 – $1,137 | 5,759 | 5 |
| Biloxi, MS | $408.54 | $20.32 – $439.59 | 5,760 | 3 |
| Willimantic, CT | $216.93 | $42.04 – $401.86 | 5,771 | 2 |
| Panama City, FL | $67.00 | $24.89 – $117.71 | 5,774 | 9 |
| Beckley, WV | $189.96 | $70.66 – $340.09 | 5,780 | 12 |
| Staten Island, NY | $549.90 | $53.71 – $964.15 | 5,791 | 13 |
| Chattanooga, TN | $235.81 | $0.00 – $708.80 | 5,796 | 12 |
| Rockville, MD | $90.80 | $29.07 – $207.56 | 5,823 | 9 |
| Lafayette, LA | $190.38 | $20.29 – $280.02 | 5,845 | 17 |
| Prestonsburg, KY | $178.37 | $81.22 – $332.48 | 5,876 | 4 |
| Anderson, IN | $105.96 | $45.50 – $181.97 | 5,915 | 11 |
| Morehead, KY | $176.14 | $85.47 – $252.46 | 5,921 | 2 |
| South Charleston, WV | $192.89 | $60.63 – $253.13 | 5,922 | 4 |
| Clive, IA | $235.67 | $85.49 – $315.93 | 5,925 | 16 |
| Temecula, CA | $224.20 | $39.97 – $325.24 | 5,939 | 5 |
| Pine Bluff, AR | $205.88 | $64.19 – $234.97 | 5,964 | 5 |
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.