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 |
|---|---|---|---|---|
| Brooklyn, NY | $322.26 | $35.23 – $1,180 | 138,581 | 113 |
| New York, NY | $375.46 | $41.70 – $690.18 | 133,047 | 106 |
| Flushing, NY | $306.22 | $54.96 – $1,047 | 93,103 | 35 |
| Phoenix, AZ | $302.49 | $63.66 – $1,213 | 71,548 | 71 |
| Bakersfield, CA | $392.48 | $49.28 – $1,503 | 66,129 | 26 |
| Los Angeles, CA | $140.58 | $0.00 – $1,033 | 60,228 | 72 |
| Tucson, AZ | $288.42 | $65.64 – $641.12 | 55,967 | 58 |
| Detroit, MI | $206.86 | $61.65 – $385.78 | 50,758 | 16 |
| Milwaukee, WI | $194.85 | $117.58 – $518.79 | 46,905 | 54 |
| Louisville, KY | $336.87 | $68.85 – $1,107 | 46,818 | 46 |
| Monterey Park, CA | $129.55 | $43.21 – $163.06 | 43,542 | 14 |
| Bronx, NY | $462.39 | $56.44 – $841.75 | 41,704 | 53 |
| San Diego, CA | $268.12 | $0.00 – $430.77 | 39,355 | 39 |
| Albuquerque, NM | $276.91 | $50.56 – $406.63 | 38,906 | 42 |
| Grand Rapids, MI | $166.51 | $57.60 – $361.31 | 38,502 | 10 |
| Lexington, KY | $300.49 | $41.70 – $618.77 | 36,613 | 39 |
| New Iberia, LA | $100.50 | $75.49 – $138.68 | 33,727 | 4 |
| Columbus, OH | $323.93 | $66.40 – $749.25 | 33,220 | 47 |
| Las Vegas, NV | $131.27 | $2.96 – $258.18 | 32,547 | 44 |
| Fresno, CA | $13.14 | $0.00 – $173.19 | 31,067 | 37 |
| Spokane, WA | $206.33 | $38.93 – $403.70 | 30,888 | 28 |
| Knoxville, TN | $293.51 | $7.75 – $436.02 | 30,472 | 22 |
| Cleveland, OH | $365.50 | $52.55 – $620.01 | 29,996 | 51 |
| Richmond, VA | $505.38 | $42.50 – $765.44 | 29,964 | 33 |
| Seattle, WA | $297.59 | $37.82 – $615.92 | 28,654 | 40 |
| Anaheim, CA | $145.82 | $0.87 – $260.79 | 28,238 | 20 |
| Boston, MA | $633.24 | $0.00 – $1,046 | 25,669 | 58 |
| Mesa, AZ | $178.78 | $73.22 – $379.09 | 25,293 | 26 |
| Washington, DC | $491.43 | $49.63 – $1,377 | 24,318 | 48 |
| Chula Vista, CA | $278.95 | $129.29 – $384.07 | 24,170 | 8 |
| New Orleans, LA | $195.05 | $24.56 – $395.67 | 24,113 | 41 |
| Cincinnati, OH | $270.58 | $53.21 – $467.67 | 24,007 | 63 |
| Hammond, LA | $127.00 | $86.44 – $157.88 | 22,611 | 5 |
| Ashland, KY | $232.63 | $68.69 – $368.47 | 22,082 | 10 |
| Las Cruces, NM | $239.38 | $98.22 – $369.70 | 21,844 | 15 |
| Ann Arbor, MI | $174.20 | $60.25 – $641.42 | 21,686 | 8 |
| Dayton, OH | $209.89 | $74.24 – $770.11 | 21,685 | 41 |
| Gilbert, AZ | $206.00 | $59.87 – $319.35 | 21,336 | 20 |
| Shreveport, LA | $186.95 | $17.26 – $360.50 | 21,145 | 30 |
| Newark, NJ | $735.20 | $76.75 – $1,845 | 21,018 | 14 |
| Yuma, AZ | $238.88 | $29.55 – $378.95 | 20,907 | 9 |
| Memphis, TN | $180.39 | $1.13 – $667.61 | 20,859 | 26 |
| Jackson, TN | $157.07 | $6.67 – $244.77 | 19,927 | 9 |
| Glendale, CA | $36.19 | $0.22 – $150.03 | 19,879 | 18 |
| Kingsport, TN | $131.82 | $68.29 – $442.01 | 19,493 | 15 |
| Flowood, MS | $134.99 | $35.08 – $192.66 | 19,064 | 17 |
| Hartford, CT | $424.42 | $24.98 – $626.08 | 18,962 | 16 |
| Clifton, NJ | $319.28 | $41.94 – $753.01 | 18,839 | 13 |
| Chicago, IL | $190.48 | $73.79 – $359.06 | 18,785 | 68 |
| Indianapolis, IN | $223.79 | $43.90 – $907.70 | 18,585 | 71 |
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.