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 |
|---|---|---|---|---|
| Louisa, KY | $207.90 | $81.55 – $328.00 | 7,053 | 2 |
| Escondido, CA | $285.26 | $83.78 – $361.48 | 7,076 | 4 |
| Mount Laurel, NJ | $377.84 | $310.45 – $489.32 | 7,096 | 15 |
| Monroe, LA | $102.71 | $64.84 – $234.48 | 7,097 | 7 |
| Englewood, NJ | $1,042 | $61.47 – $1,059 | 7,122 | 3 |
| Florence, SC | $33.87 | $18.19 – $62.34 | 7,174 | 12 |
| Anniston, AL | $104.05 | $88.44 – $127.16 | 7,202 | 4 |
| Portsmouth, OH | $193.63 | $86.38 – $492.97 | 7,299 | 5 |
| Royal Oak, MI | $164.78 | $63.55 – $313.67 | 7,324 | 6 |
| Covington, LA | $158.95 | $38.55 – $366.31 | 7,399 | 6 |
| Norwalk, CT | $359.21 | $0.00 – $551.58 | 7,428 | 8 |
| Coral Gables, FL | $127.54 | $2.10 – $266.70 | 7,438 | 5 |
| Jackson Heights, NY | $189.33 | $116.76 – $348.23 | 7,451 | 5 |
| Rialto, CA | $294.13 | $185.24 – $371.24 | 7,485 | 6 |
| Rochester Hills, MI | $69.36 | $59.72 – $70.51 | 7,500 | 3 |
| Orange, CA | $127.92 | $9.47 – $277.21 | 7,542 | 12 |
| Powell, TN | $137.53 | $137.01 – $142.44 | 7,567 | 2 |
| Muskegon, MI | $196.43 | $62.17 – $326.28 | 7,582 | 3 |
| Roanoke, VA | $503.64 | $46.11 – $553.13 | 7,587 | 13 |
| Troy, MI | $383.05 | $59.87 – $405.31 | 7,603 | 3 |
| Bellingham, WA | $135.46 | $48.90 – $214.42 | 7,607 | 8 |
| Newark, DE | $134.57 | $0.00 – $216.15 | 7,651 | 8 |
| Modesto, CA | $163.62 | $0.00 – $336.93 | 7,660 | 16 |
| Saint Louis, MO | $248.09 | $36.37 – $1,037 | 7,664 | 33 |
| Salinas, CA | $173.77 | $50.51 – $383.47 | 7,722 | 7 |
| Ponce, PR | $252.71 | $99.56 – $380.00 | 7,755 | 16 |
| N Las Vegas, NV | $85.37 | $14.53 – $87.40 | 7,766 | 4 |
| Steubenville, OH | $198.57 | $134.83 – $384.59 | 7,791 | 3 |
| Mayfield, KY | $204.04 | $70.15 – $364.37 | 7,812 | 3 |
| Jackson, MI | $148.83 | $52.46 – $295.37 | 7,861 | 4 |
| Wallingford, CT | $12.74 | $11.01 – $50.69 | 7,861 | 2 |
| Portland, ME | $314.99 | $51.18 – $372.49 | 7,910 | 12 |
| Huntington, WV | $160.65 | $50.06 – $274.59 | 8,087 | 9 |
| Owensboro, KY | $306.63 | $77.14 – $416.23 | 8,091 | 7 |
| Jackson, MS | $315.15 | $26.22 – $1,578 | 8,123 | 17 |
| Voorhees, NJ | $417.18 | $78.24 – $1,162 | 8,131 | 9 |
| Kansas City, MO | $314.39 | $106.48 – $747.68 | 8,154 | 21 |
| Baton Rouge, LA | $138.73 | $39.84 – $249.49 | 8,160 | 20 |
| Albany, NY | $523.85 | $47.25 – $748.45 | 8,244 | 11 |
| Wichita, KS | $169.17 | $63.29 – $184.64 | 8,259 | 14 |
| Danbury, CT | $337.25 | $43.76 – $422.25 | 8,322 | 10 |
| Victorville, CA | $265.28 | $44.71 – $420.10 | 8,436 | 9 |
| Santa Maria, CA | $192.05 | $27.57 – $275.63 | 8,452 | 8 |
| Thornton, CO | $120.17 | $2.37 – $167.71 | 8,493 | 8 |
| Lima, OH | $149.51 | $71.13 – $407.51 | 8,561 | 14 |
| Norfolk, VA | $596.81 | $74.36 – $856.10 | 8,668 | 14 |
| Avondale, AZ | $171.14 | $84.85 – $202.91 | 8,711 | 4 |
| Charlottesville, VA | $748.90 | $56.42 – $829.22 | 8,718 | 12 |
| New Brunswick, NJ | $896.31 | $73.62 – $1,262 | 8,821 | 11 |
| Crestview Hills, KY | $146.65 | $71.65 – $248.75 | 8,843 | 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.