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 |
|---|---|---|---|---|
| Camden, SC | $0.00 | $0.00 – $0.00 | 30 | 1 |
| Elgin, IL | $162.28 | $142.06 – $179.97 | 30 | 2 |
| Hobbs, NM | $395.99 | $395.99 – $395.99 | 30 | 1 |
| Franklin, PA | $86.56 | $86.56 – $86.56 | 30 | 1 |
| Reedsport, OR | $549.75 | $549.75 – $549.75 | 30 | 1 |
| Pine Ridge Sd, SD | $427.00 | $427.00 – $427.00 | 30 | 1 |
| Dekalb, IL | $159.23 | $159.23 – $159.23 | 31 | 1 |
| Middlebury, CT | $71.45 | $71.45 – $71.45 | 31 | 1 |
| Morrilton, AR | $146.52 | $146.52 – $146.52 | 31 | 1 |
| Williamstown, KY | $104.73 | $104.73 – $104.73 | 31 | 1 |
| Colusa, CA | $93.02 | $93.02 – $93.02 | 32 | 1 |
| Dublin, CA | $92.73 | $92.73 – $92.73 | 32 | 1 |
| Bluefield, WV | $183.01 | $183.01 – $183.01 | 33 | 1 |
| Mount Vernon, IL | $236.34 | $236.34 – $236.34 | 33 | 1 |
| Tazewell, TN | $74.13 | $74.13 – $74.13 | 33 | 1 |
| Camp Lejeune, NC | $55.87 | $55.87 – $55.87 | 34 | 1 |
| Miramar Beach, FL | $105.53 | $60.93 – $140.74 | 34 | 2 |
| Circleville, OH | $508.69 | $508.69 – $508.69 | 34 | 1 |
| Willowbrook, IL | $182.03 | $182.03 – $182.03 | 34 | 1 |
| Hudson, FL | $383.39 | $383.39 – $383.39 | 35 | 1 |
| Grayling, MI | $199.27 | $56.78 – $333.85 | 35 | 2 |
| Needham, MA | $836.32 | $836.32 – $836.32 | 36 | 1 |
| Advance, NC | $212.47 | $212.47 – $212.47 | 36 | 1 |
| Westminster, CO | $98.99 | $98.99 – $98.99 | 37 | 1 |
| Kailua Kona, HI | $40.69 | $29.48 – $61.39 | 37 | 2 |
| Grundy, VA | $115.53 | $30.64 – $167.20 | 37 | 2 |
| Lansdale, PA | $88.22 | $88.22 – $88.22 | 37 | 1 |
| Seaman, OH | $511.24 | $511.24 – $511.24 | 37 | 1 |
| Lake St Louis, MO | $134.17 | $134.17 – $134.17 | 37 | 1 |
| Brentwood, CA | $50.00 | $50.00 – $50.00 | 37 | 1 |
| Evans Mills, NY | $90.11 | $90.11 – $90.11 | 37 | 1 |
| Branford, CT | $34.99 | $20.75 – $65.83 | 38 | 2 |
| Orchard Park, NY | $349.20 | $349.20 – $349.20 | 38 | 1 |
| Lynnwood, WA | $215.05 | $215.05 – $215.05 | 38 | 1 |
| Bellerose, NY | $74.82 | $74.82 – $74.82 | 38 | 1 |
| Nyack, NY | $674.64 | $674.64 – $674.64 | 38 | 1 |
| Brookhaven, MS | $213.39 | $213.39 – $213.39 | 38 | 1 |
| Shelton, CT | $83.30 | $83.30 – $83.30 | 39 | 1 |
| Klamath Falls, OR | $258.37 | $258.37 – $258.37 | 39 | 1 |
| Mission, TX | $15.28 | $15.28 – $15.28 | 39 | 1 |
| Ada, OK | $134.44 | $134.44 – $134.44 | 39 | 1 |
| Bellaire, OH | $84.66 | $84.66 – $84.66 | 39 | 1 |
| Brighton, MA | $264.29 | $11.19 – $636.82 | 39 | 3 |
| Belpre, OH | $541.86 | $541.86 – $541.86 | 39 | 1 |
| Ewa Beach, HI | $227.62 | $114.16 – $278.05 | 39 | 2 |
| Dorchester Center, MA | $608.95 | $608.95 – $608.95 | 39 | 1 |
| Dayton, TN | $128.04 | $128.04 – $128.04 | 40 | 1 |
| Payson, AZ | $411.01 | $55.41 – $648.07 | 40 | 2 |
| Orwigsburg, PA | $156.28 | $156.28 – $156.28 | 40 | 1 |
| Butte, MT | $0.00 | $0.00 – $0.00 | 40 | 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.