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 |
|---|---|---|---|---|
| Bristol, CT | $422.80 | $48.53 – $476.62 | 2,876 | 3 |
| Appleton, WI | $159.72 | $64.75 – $417.87 | 2,871 | 6 |
| Puyallup, WA | $169.52 | $50.34 – $310.23 | 2,862 | 8 |
| Watchung, NJ | $400.59 | $400.59 – $400.59 | 2,856 | 1 |
| Ashtabula, OH | $234.18 | $78.62 – $424.81 | 2,841 | 4 |
| Paramus, NJ | $326.62 | $97.00 – $463.58 | 2,839 | 3 |
| Lincolnton, NC | $93.17 | $86.54 – $100.10 | 2,836 | 2 |
| Trumbull, CT | $58.06 | $48.28 – $83.04 | 2,830 | 5 |
| Chalmette, LA | $255.94 | $255.94 – $255.94 | 2,829 | 1 |
| Carbondale, IL | $157.60 | $129.26 – $162.24 | 2,828 | 3 |
| Lenoir City, TN | $195.90 | $195.90 – $195.90 | 2,824 | 1 |
| Crown Point, IN | $315.12 | $142.08 – $488.27 | 2,816 | 3 |
| Saint Clair Shores, MI | $61.06 | $49.49 – $88.69 | 2,816 | 3 |
| Conway, SC | $41.34 | $10.46 – $90.87 | 2,810 | 3 |
| Michigan City, IN | $313.01 | $283.38 – $652.32 | 2,790 | 3 |
| Lighthouse Point, FL | $42.18 | $39.70 – $58.52 | 2,775 | 4 |
| Sioux City, IA | $277.13 | $85.86 – $462.97 | 2,774 | 5 |
| Tustin, CA | $69.23 | $7.24 – $205.72 | 2,766 | 6 |
| Derby, CT | $496.67 | $496.67 – $496.67 | 2,753 | 1 |
| Provo, UT | $141.08 | $14.88 – $177.02 | 2,749 | 5 |
| Kingman, AZ | $514.33 | $87.06 – $802.74 | 2,747 | 2 |
| Neenah, WI | $184.68 | $157.88 – $189.89 | 2,735 | 2 |
| Cape Coral, FL | $118.39 | $46.39 – $185.65 | 2,735 | 2 |
| West Allis, WI | $165.92 | $133.66 – $193.93 | 2,724 | 4 |
| Goldsboro, NC | $70.63 | $64.54 – $70.80 | 2,723 | 2 |
| Huntington Beach, CA | $264.60 | $2.06 – $926.00 | 2,722 | 4 |
| Olympia, WA | $175.87 | $38.17 – $212.13 | 2,707 | 7 |
| Grass Valley, CA | $65.03 | $53.57 – $77.75 | 2,705 | 4 |
| Johnson City, TN | $125.09 | $58.08 – $598.18 | 2,701 | 8 |
| Summerville, SC | $120.24 | $31.50 – $138.84 | 2,678 | 6 |
| Clarksville, TN | $127.25 | $121.20 – $128.09 | 2,676 | 2 |
| Slidell, LA | $258.19 | $59.64 – $264.78 | 2,665 | 3 |
| Doral, FL | $34.40 | $29.94 – $68.60 | 2,647 | 3 |
| Burlington, MA | $719.42 | $54.23 – $728.81 | 2,638 | 4 |
| Gainesville, GA | $156.80 | $128.06 – $157.96 | 2,636 | 2 |
| Stratford, NJ | $1,150 | $1,150 – $1,150 | 2,624 | 1 |
| Racine, WI | $164.64 | $164.64 – $164.64 | 2,619 | 1 |
| Saint Clairsville, OH | $273.89 | $127.79 – $328.04 | 2,615 | 2 |
| Montclair, NJ | $503.04 | $205.64 – $566.30 | 2,611 | 2 |
| Wenatchee, WA | $269.77 | $48.47 – $314.71 | 2,610 | 5 |
| Harlan, KY | $320.26 | $113.78 – $421.55 | 2,595 | 2 |
| Fairfield, CA | $223.33 | $45.10 – $293.18 | 2,589 | 7 |
| Cleveland Hts, OH | $197.20 | $197.20 – $197.20 | 2,579 | 1 |
| Battle Creek, MI | $226.95 | $63.09 – $365.14 | 2,577 | 2 |
| Christiansburg, VA | $346.10 | $41.01 – $392.69 | 2,573 | 5 |
| Salem, IN | $442.84 | $442.84 – $442.84 | 2,570 | 1 |
| Aurora, CO | $252.69 | $76.68 – $953.15 | 2,567 | 20 |
| Flemington, NJ | $873.64 | $364.07 – $1,394 | 2,560 | 3 |
| Flagstaff, AZ | $191.18 | $82.56 – $725.09 | 2,553 | 5 |
| Edgewood, KY | $382.13 | $382.13 – $382.13 | 2,536 | 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.