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 |
|---|---|---|---|---|
| Munster, IN | $328.50 | $61.45 – $927.71 | 3,298 | 11 |
| Fishersville, VA | $360.17 | $51.40 – $487.20 | 3,290 | 7 |
| Pittsfield, MA | $480.72 | $33.86 – $729.92 | 3,265 | 7 |
| St Petersburg, FL | $143.40 | $36.79 – $172.24 | 3,261 | 7 |
| Farmington, NM | $320.40 | $111.94 – $442.91 | 3,256 | 4 |
| Pittsburgh, PA | $201.22 | $1.16 – $483.97 | 3,232 | 27 |
| Stanford, CA | $141.66 | $36.55 – $406.10 | 3,232 | 21 |
| Mission Viejo, CA | $188.12 | $0.19 – $205.54 | 3,220 | 4 |
| Bettendorf, IA | $177.99 | $74.92 – $246.77 | 3,210 | 6 |
| Utica, NY | $458.50 | $51.80 – $673.84 | 3,207 | 10 |
| Troy, NY | $530.67 | $72.16 – $550.92 | 3,206 | 3 |
| Newburgh, IN | $164.16 | $74.82 – $221.18 | 3,181 | 12 |
| Pennington, NJ | $1,343 | $162.95 – $2,231 | 3,180 | 5 |
| Rockport, ME | $180.53 | $70.83 – $330.67 | 3,168 | 4 |
| Lompoc, CA | $153.07 | $89.59 – $154.62 | 3,160 | 2 |
| Rockville Centre, NY | $739.61 | $142.43 – $750.02 | 3,150 | 3 |
| Passaic, NJ | $419.19 | $419.19 – $419.19 | 3,125 | 1 |
| Fair Lawn, NJ | $152.07 | $36.56 – $420.51 | 3,116 | 6 |
| Manati, PR | $344.02 | $82.17 – $396.31 | 3,105 | 6 |
| Sun City, AZ | $160.24 | $59.29 – $204.60 | 3,100 | 6 |
| Manahawkin, NJ | $399.10 | $85.12 – $1,236 | 3,099 | 7 |
| Lovington, NM | $351.98 | $284.36 – $430.17 | 3,092 | 2 |
| Lumberton, NC | $68.45 | $57.08 – $148.60 | 3,080 | 5 |
| Maryville, TN | $194.12 | $64.29 – $207.27 | 3,072 | 8 |
| Burien, WA | $269.84 | $47.15 – $316.03 | 3,062 | 4 |
| Glendora, CA | $76.76 | $33.30 – $110.10 | 3,058 | 4 |
| Clinton Township, MI | $68.79 | $60.10 – $68.99 | 3,054 | 3 |
| Barbourville, KY | $472.19 | $74.18 – $771.96 | 3,047 | 2 |
| Idaho Falls, ID | $142.86 | $96.38 – $241.00 | 3,046 | 12 |
| Owosso, MI | $182.94 | $60.37 – $333.16 | 3,034 | 3 |
| Lubbock, TX | $216.41 | $6.67 – $476.94 | 3,031 | 15 |
| Poughkeepsie, NY | $404.60 | $104.06 – $834.69 | 3,008 | 10 |
| Mentor, OH | $222.15 | $89.54 – $276.45 | 2,988 | 4 |
| Alliance, OH | $185.31 | $167.44 – $374.34 | 2,987 | 2 |
| Silver Spring, MD | $43.18 | $40.11 – $97.51 | 2,975 | 2 |
| Middletown, NY | $530.74 | $125.51 – $826.91 | 2,969 | 8 |
| Concord, NC | $155.26 | $48.84 – $345.91 | 2,954 | 7 |
| Thibodaux, LA | $218.10 | $32.99 – $288.90 | 2,953 | 4 |
| Springfield, MO | $282.30 | $0.00 – $526.48 | 2,950 | 16 |
| Stony Brook, NY | $468.72 | $44.25 – $521.38 | 2,949 | 4 |
| Clovis, NM | $244.71 | $96.68 – $366.39 | 2,930 | 7 |
| Chino, CA | $167.00 | $158.71 – $245.46 | 2,923 | 4 |
| Danville, VA | $242.72 | $21.72 – $309.32 | 2,920 | 3 |
| Midland, MI | $109.51 | $65.32 – $201.65 | 2,912 | 4 |
| Greeley, CO | $144.75 | $0.00 – $208.19 | 2,910 | 11 |
| Issaquah, WA | $352.48 | $47.54 – $362.96 | 2,904 | 4 |
| Henderson, NV | $86.83 | $21.62 – $136.62 | 2,897 | 10 |
| Providence, RI | $167.07 | $99.83 – $526.14 | 2,892 | 26 |
| Paintsville, KY | $189.66 | $64.76 – $229.28 | 2,886 | 4 |
| Greenwood, SC | $217.89 | $0.00 – $260.25 | 2,883 | 7 |
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.