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 |
|---|---|---|---|---|
| Conway, AR | $105.48 | $105.48 – $105.48 | 51 | 1 |
| Kerrville, TX | $38.74 | $38.74 – $38.74 | 51 | 1 |
| Bayonne, NJ | $172.31 | $172.31 – $172.31 | 51 | 1 |
| Carrollton, GA | $199.05 | $199.05 – $199.05 | 51 | 1 |
| Prosper, TX | $137.77 | $112.72 – $211.01 | 51 | 2 |
| Okeechobee, FL | $20.99 | $20.99 – $20.99 | 51 | 1 |
| Foley, AL | $135.43 | $135.43 – $135.43 | 51 | 1 |
| Ludington, MI | $147.64 | $59.49 – $323.93 | 51 | 2 |
| Troy, AL | $87.44 | $87.44 – $87.44 | 51 | 1 |
| Lafayette, CA | $20.90 | $20.90 – $20.90 | 51 | 1 |
| Shadyside, PA | $135.08 | $135.08 – $135.08 | 51 | 1 |
| Pickerington, OH | $110.58 | $90.88 – $117.15 | 52 | 2 |
| Gold Beach, OR | $238.66 | $238.66 – $238.66 | 52 | 1 |
| Chelmsford, MA | $47.79 | $31.94 – $83.46 | 52 | 2 |
| Glen Cove, NY | $306.90 | $306.90 – $306.90 | 52 | 1 |
| Mullins, SC | $0.00 | $0.00 – $0.00 | 52 | 2 |
| Bennington, VT | $10.51 | $10.51 – $10.51 | 52 | 1 |
| Gonzales, CA | $76.11 | $76.11 – $76.11 | 52 | 1 |
| Rio Grande, PR | $201.70 | $201.70 – $201.70 | 52 | 1 |
| Hazle Township, PA | $124.50 | $97.69 – $167.93 | 52 | 3 |
| Redmond, OR | $116.57 | $106.75 – $127.32 | 53 | 3 |
| West Paterson, NJ | $252.46 | $252.46 – $252.46 | 53 | 1 |
| Bridgeton, NJ | $232.17 | $232.17 – $232.17 | 53 | 1 |
| Ogdensburg, NY | $708.97 | $708.97 – $708.97 | 53 | 1 |
| Bluffton, OH | $450.98 | $450.98 – $450.98 | 53 | 1 |
| Lorton, VA | $117.70 | $117.70 – $117.70 | 53 | 1 |
| Marietta, GA | $155.53 | $155.53 – $155.53 | 54 | 1 |
| Oakland, MD | $84.18 | $84.18 – $84.18 | 54 | 1 |
| Franklin, OH | $362.64 | $362.64 – $362.64 | 54 | 1 |
| Granite Falls, NC | $216.36 | $216.36 – $216.36 | 54 | 1 |
| Pompton Plains, NJ | $781.43 | $781.43 – $781.43 | 54 | 1 |
| Ottumwa, IA | $169.14 | $169.14 – $169.14 | 55 | 1 |
| Greensboro, NC | $88.18 | $43.13 – $159.64 | 55 | 4 |
| Ankeny, IA | $322.55 | $322.55 – $322.55 | 55 | 1 |
| Mankato, MN | $159.96 | $52.86 – $446.92 | 55 | 3 |
| Jonesboro, GA | $90.75 | $70.53 – $144.66 | 55 | 2 |
| Versailles, KY | $193.84 | $106.54 – $475.87 | 55 | 2 |
| Rhinelander, WI | $200.64 | $200.64 – $200.64 | 55 | 1 |
| Flora, IL | $169.02 | $169.02 – $169.02 | 55 | 1 |
| Hershey, PA | $229.80 | $72.92 – $388.18 | 56 | 3 |
| Sequim, WA | $39.75 | $33.48 – $41.84 | 56 | 2 |
| Batesville, MS | $419.84 | $419.84 – $419.84 | 56 | 1 |
| Opelika, AL | $129.15 | $129.15 – $129.15 | 56 | 1 |
| Langhorne, PA | $151.45 | $151.45 – $151.45 | 57 | 1 |
| Plymouth, MN | $270.43 | $68.45 – $324.28 | 57 | 2 |
| Castro Valley, CA | $459.76 | $459.76 – $459.76 | 57 | 1 |
| Nogales, AZ | $652.64 | $652.64 – $652.64 | 57 | 1 |
| Hudson, OH | $205.17 | $126.15 – $295.90 | 58 | 2 |
| Rye Brook, NY | $323.20 | $323.20 – $323.20 | 58 | 1 |
| Hicksville, NY | $100.44 | $100.44 – $100.44 | 58 | 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.