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 |
|---|---|---|---|---|
| Madisonville, KY | $224.68 | $72.89 – $333.65 | 11,548 | 3 |
| Colorado Springs, CO | $169.62 | $61.23 – $441.81 | 11,570 | 26 |
| Tampa, FL | $148.64 | $16.42 – $382.00 | 11,618 | 31 |
| Bridgeport, CT | $474.59 | $61.13 – $605.71 | 11,631 | 4 |
| Corbin, KY | $185.78 | $74.38 – $270.03 | 11,649 | 9 |
| Oakland, CA | $161.89 | $9.09 – $625.77 | 11,724 | 17 |
| San Jose, CA | $174.37 | $1.80 – $340.63 | 11,784 | 25 |
| Kalamazoo, MI | $150.57 | $59.57 – $344.97 | 11,826 | 5 |
| Gonzales, LA | $194.38 | $172.59 – $208.15 | 11,862 | 3 |
| Paterson, NJ | $466.13 | $56.79 – $570.17 | 11,926 | 4 |
| Baltimore, MD | $79.69 | $0.00 – $599.30 | 12,111 | 47 |
| Merced, CA | $194.55 | $70.76 – $292.99 | 12,278 | 8 |
| Pueblo, CO | $208.88 | $110.00 – $231.63 | 12,427 | 10 |
| San Juan, PR | $289.60 | $51.22 – $367.31 | 12,587 | 31 |
| Richmond, IN | $531.41 | $39.45 – $605.34 | 12,692 | 3 |
| Green Bay, WI | $171.00 | $66.69 – $188.15 | 12,917 | 17 |
| Rego Park, NY | $458.11 | $118.98 – $510.37 | 12,963 | 7 |
| Poplar Bluff, MO | $266.89 | $266.89 – $266.89 | 13,127 | 1 |
| Charleston, SC | $56.84 | $0.00 – $228.64 | 13,193 | 24 |
| Bowling Green, KY | $175.42 | $75.22 – $261.03 | 13,321 | 10 |
| Pikeville, KY | $173.31 | $71.81 – $243.98 | 13,414 | 7 |
| Charleston, WV | $172.41 | $31.96 – $527.95 | 13,485 | 20 |
| Elizabethtown, KY | $242.04 | $81.66 – $457.11 | 13,491 | 5 |
| Orlando, FL | $203.65 | $0.00 – $928.75 | 13,837 | 42 |
| Glendale, AZ | $177.84 | $75.19 – $509.55 | 14,092 | 19 |
| Oklahoma City, OK | $248.84 | $52.73 – $508.09 | 14,161 | 39 |
| Somerset, KY | $111.48 | $60.93 – $154.28 | 14,173 | 7 |
| Miami, FL | $131.94 | $0.00 – $355.49 | 14,244 | 31 |
| Little Rock, AR | $188.99 | $80.77 – $302.70 | 14,250 | 18 |
| Charlotte, NC | $123.85 | $11.00 – $354.93 | 14,528 | 39 |
| Toledo, OH | $261.44 | $51.80 – $559.49 | 14,620 | 24 |
| Akron, OH | $354.85 | $104.16 – $715.74 | 14,626 | 20 |
| Greenville, NC | $91.28 | $24.48 – $586.00 | 14,831 | 20 |
| Canton, OH | $204.82 | $105.68 – $453.33 | 15,060 | 10 |
| Westminster, CA | $121.38 | $3.28 – $211.61 | 15,264 | 7 |
| Lancaster, CA | $140.60 | $81.88 – $184.35 | 15,267 | 14 |
| Irvine, CA | $196.99 | $39.68 – $253.39 | 15,506 | 9 |
| Warren, OH | $218.25 | $62.73 – $531.76 | 15,724 | 17 |
| Palm Springs, CA | $212.01 | $46.73 – $343.50 | 15,888 | 7 |
| Fremont, CA | $234.65 | $67.30 – $411.85 | 16,011 | 11 |
| Philadelphia, PA | $374.90 | $0.00 – $2,094 | 16,447 | 77 |
| Meriden, CT | $203.82 | $30.61 – $415.98 | 16,792 | 7 |
| Sacramento, CA | $168.97 | $0.00 – $719.83 | 16,930 | 49 |
| Riverside, CA | $297.04 | $13.91 – $754.10 | 17,000 | 18 |
| Camden, NJ | $1,086 | $155.36 – $1,173 | 17,176 | 9 |
| Saginaw, MI | $160.58 | $60.23 – $327.94 | 17,815 | 9 |
| Tacoma, WA | $216.07 | $34.58 – $651.95 | 17,963 | 27 |
| Nashville, TN | $223.12 | $1.71 – $735.75 | 18,196 | 37 |
| Waterbury, CT | $305.03 | $27.04 – $504.28 | 18,232 | 14 |
| Flint, MI | $184.08 | $45.45 – $361.93 | 18,374 | 14 |
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.