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 |
|---|---|---|---|---|
| Oak Park, IL | $203.05 | $164.84 – $203.43 | 2,532 | 2 |
| Boardman, OH | $278.23 | $83.38 – $281.36 | 2,530 | 3 |
| East Chicago, IN | $326.41 | $326.41 – $326.41 | 2,524 | 1 |
| Libertyville, IL | $162.79 | $111.61 – $203.72 | 2,519 | 5 |
| Carolina, PR | $282.93 | $266.14 – $432.31 | 2,515 | 3 |
| Livingston, NJ | $1,008 | $170.51 – $2,204 | 2,512 | 5 |
| Coral Springs, FL | $133.12 | $86.42 – $250.52 | 2,510 | 3 |
| Wartburg, TN | $23.36 | $23.36 – $23.36 | 2,498 | 1 |
| Petoskey, MI | $232.11 | $61.73 – $339.60 | 2,498 | 3 |
| Normal, IL | $127.53 | $48.80 – $129.31 | 2,493 | 2 |
| Orange City, FL | $125.61 | $17.68 – $182.68 | 2,493 | 10 |
| La Porte, IN | $279.62 | $82.32 – $332.83 | 2,481 | 2 |
| Enumclaw, WA | $584.46 | $38.21 – $720.01 | 2,465 | 3 |
| Manchester, KY | $227.46 | $70.83 – $358.96 | 2,463 | 3 |
| Greenwood, MS | $169.03 | $49.96 – $278.87 | 2,457 | 2 |
| Indio, CA | $41.68 | $41.68 – $41.68 | 2,451 | 1 |
| Valhalla, NY | $772.03 | $55.59 – $803.94 | 2,441 | 6 |
| Sun City West, AZ | $208.23 | $75.65 – $269.99 | 2,432 | 3 |
| Ukiah, CA | $150.06 | $60.76 – $267.55 | 2,427 | 6 |
| Casper, WY | $92.82 | $14.60 – $105.69 | 2,425 | 3 |
| Springboro, OH | $145.95 | $80.22 – $207.08 | 2,414 | 5 |
| Boys Town, NE | $145.84 | $87.52 – $153.26 | 2,410 | 4 |
| Boynton Beach, FL | $180.30 | $91.24 – $270.68 | 2,408 | 3 |
| Colton, CA | $107.49 | $37.14 – $415.98 | 2,407 | 2 |
| La Quinta, CA | $152.18 | $152.18 – $152.18 | 2,396 | 1 |
| Dunn, NC | $36.76 | $36.76 – $36.76 | 2,394 | 1 |
| Longview, WA | $262.46 | $43.42 – $301.57 | 2,383 | 3 |
| Aguadilla, PR | $332.48 | $328.21 – $355.80 | 2,381 | 2 |
| Troy, OH | $210.48 | $124.96 – $348.00 | 2,372 | 5 |
| Maywood, NJ | $306.25 | $220.38 – $308.52 | 2,371 | 2 |
| Wilmington, DE | $605.20 | $148.33 – $1,766 | 2,366 | 8 |
| Henderson, KY | $283.25 | $83.35 – $384.35 | 2,352 | 4 |
| Livonia, MI | $225.33 | $69.08 – $355.72 | 2,345 | 4 |
| Pontiac, MI | $356.88 | $68.89 – $1,130 | 2,345 | 4 |
| Plainville, CT | $88.66 | $88.66 – $88.66 | 2,336 | 1 |
| Lynchburg, VA | $271.77 | $96.96 – $383.11 | 2,332 | 7 |
| San Bernardino, CA | $207.61 | $33.26 – $253.19 | 2,332 | 5 |
| Poland, OH | $166.39 | $165.96 – $203.49 | 2,330 | 2 |
| Portage, IN | $155.46 | $155.46 – $155.46 | 2,321 | 1 |
| Sewell, NJ | $319.93 | $82.30 – $344.97 | 2,320 | 3 |
| Belleville, IL | $157.42 | $86.25 – $179.71 | 2,319 | 3 |
| Eau Claire, WI | $136.75 | $40.26 – $247.59 | 2,315 | 10 |
| Garden City, NY | $315.54 | $178.33 – $419.66 | 2,310 | 5 |
| Fairhaven, MA | $48.71 | $40.06 – $60.05 | 2,310 | 5 |
| Santa Fe, NM | $237.45 | $109.60 – $538.73 | 2,309 | 9 |
| Mansfield, OH | $248.27 | $166.26 – $323.80 | 2,306 | 4 |
| Brentwood, TN | $356.70 | $356.70 – $356.70 | 2,304 | 1 |
| Columbus, MS | $111.66 | $0.00 – $114.77 | 2,300 | 4 |
| Harrisonburg, VA | $387.59 | $73.59 – $517.48 | 2,300 | 5 |
| Holyoke, MA | $553.83 | $53.22 – $607.92 | 2,297 | 4 |
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.