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 |
|---|---|---|---|---|
| Concord Twp, OH | $169.33 | $169.33 – $169.33 | 26 | 1 |
| Kailua, HI | $433.13 | $433.13 – $433.13 | 26 | 1 |
| Burlington, NC | $63.25 | $63.25 – $63.25 | 27 | 1 |
| Sunnyside, WA | $210.19 | $53.11 – $335.85 | 27 | 2 |
| Gloucester, VA | $574.33 | $574.33 – $574.33 | 27 | 1 |
| Lebanon, KY | $221.12 | $221.12 – $221.12 | 27 | 1 |
| Wheat Ridge, CO | $391.36 | $391.36 – $391.36 | 27 | 1 |
| Culpeper, VA | $245.12 | $245.12 – $245.12 | 27 | 1 |
| Reston, VA | $357.46 | $357.46 – $357.46 | 27 | 1 |
| Price, UT | $104.34 | $0.00 – $234.77 | 27 | 2 |
| Colchester, VT | $413.85 | $413.85 – $413.85 | 27 | 1 |
| Gallup, NM | $212.15 | $104.75 – $298.08 | 27 | 2 |
| Port Richey, FL | $322.25 | $322.25 – $322.25 | 27 | 1 |
| Johnstown, PA | $87.24 | $87.24 – $87.24 | 27 | 1 |
| Sunrise, FL | $81.72 | $81.72 – $81.72 | 27 | 1 |
| Fort Payne, AL | $193.23 | $193.23 – $193.23 | 27 | 1 |
| Van Wert, OH | $403.29 | $403.29 – $403.29 | 27 | 1 |
| Mcminnville, OR | $213.08 | $79.30 – $357.14 | 27 | 2 |
| Windsor, CT | $252.06 | $252.06 – $252.06 | 27 | 1 |
| Jourdanton, TX | $58.26 | $58.26 – $58.26 | 27 | 1 |
| Hartford, WI | $194.13 | $194.13 – $194.13 | 27 | 1 |
| Ste Genevieve, MO | $363.87 | $363.87 – $363.87 | 27 | 1 |
| Highland Hills, OH | $120.14 | $120.14 – $120.14 | 27 | 1 |
| Centralia, IL | $199.21 | $199.21 – $199.21 | 28 | 1 |
| Visalia, CA | $165.07 | $165.07 – $165.07 | 28 | 1 |
| Elkton, MD | $94.00 | $86.85 – $100.20 | 28 | 2 |
| Xenia, OH | $156.76 | $156.76 – $156.76 | 28 | 1 |
| Huntington Station, NY | $116.53 | $116.53 – $116.53 | 28 | 1 |
| Danville, IL | $195.25 | $168.21 – $231.30 | 28 | 2 |
| Hartsdale, NY | $62.85 | $62.85 – $62.85 | 28 | 1 |
| Christiansted, St. Croix, VI | $0.00 | $0.00 – $0.00 | 28 | 1 |
| Nellis Afb, NV | $31.89 | $31.89 – $31.89 | 28 | 1 |
| Richmond Heights, OH | $78.79 | $78.79 – $78.79 | 28 | 1 |
| Dublin, VA | $74.47 | $74.47 – $74.47 | 28 | 1 |
| Titusville, FL | $54.94 | $54.94 – $54.94 | 29 | 1 |
| Aiea, HI | $168.02 | $168.02 – $168.02 | 29 | 1 |
| Willow Grove, PA | $1,760 | $1,760 – $1,760 | 29 | 1 |
| Jacksonville, IL | $151.60 | $144.01 – $160.94 | 29 | 2 |
| North Miami, FL | $76.23 | $76.23 – $76.23 | 29 | 1 |
| Bessemer, AL | $141.73 | $141.73 – $141.73 | 29 | 1 |
| Winter Garden, FL | $47.46 | $47.46 – $47.46 | 29 | 1 |
| Calexico, CA | $0.00 | $0.00 – $0.00 | 29 | 1 |
| Sherwood, AR | $102.55 | $102.55 – $102.55 | 29 | 1 |
| Laconia, NH | $453.84 | $453.84 – $453.84 | 29 | 1 |
| Woodside, NY | $110.44 | $110.44 – $110.44 | 30 | 1 |
| Clearwater, FL | $297.16 | $297.16 – $297.16 | 30 | 1 |
| Shelton, WA | $376.80 | $376.80 – $376.80 | 30 | 1 |
| Killeen, TX | $96.01 | $96.01 – $96.01 | 30 | 1 |
| Leitchfield, KY | $298.18 | $126.97 – $555.00 | 30 | 2 |
| Athens, TN | $151.31 | $151.31 – $151.31 | 30 | 1 |
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.