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 |
|---|---|---|---|---|
| Marquette, MI | $183.54 | $70.42 – $325.21 | 2,061 | 2 |
| Florham Park, NJ | $491.76 | $491.76 – $491.76 | 2,060 | 1 |
| Kokomo, IN | $133.93 | $116.58 – $157.81 | 2,060 | 2 |
| Niagara Falls, NY | $330.63 | $98.18 – $529.42 | 2,058 | 3 |
| Rancho Mirage, CA | $283.70 | $43.24 – $309.60 | 2,056 | 4 |
| Seaford, DE | $190.97 | $1.72 – $373.22 | 2,056 | 6 |
| Marietta, OH | $227.67 | $57.85 – $263.79 | 2,028 | 4 |
| Hartford, KY | $310.26 | $84.86 – $505.54 | 2,025 | 2 |
| Brick, NJ | $317.00 | $96.16 – $908.73 | 2,020 | 10 |
| Richlands, VA | $384.97 | $56.88 – $395.23 | 2,011 | 2 |
| Capitola, CA | $72.34 | $72.34 – $72.34 | 2,010 | 1 |
| Cedar Rapids, IA | $157.65 | $84.59 – $448.09 | 2,006 | 8 |
| Helena, MT | $28.95 | $6.03 – $87.73 | 1,992 | 3 |
| Vacaville, CA | $45.26 | $45.26 – $45.26 | 1,984 | 1 |
| Lodi, CA | $93.33 | $91.89 – $210.70 | 1,978 | 2 |
| Macon, GA | $119.56 | $40.57 – $174.28 | 1,976 | 6 |
| Perth Amboy, NJ | $1,190 | $1,102 – $1,195 | 1,970 | 2 |
| Trinity, FL | $61.80 | $31.86 – $312.40 | 1,968 | 2 |
| Osage Beach, MO | $162.09 | $162.09 – $162.09 | 1,964 | 1 |
| Hamden, CT | $88.47 | $40.52 – $130.35 | 1,941 | 12 |
| Roslyn Heights, NY | $122.36 | $71.71 – $142.20 | 1,941 | 3 |
| Twin Falls, ID | $122.52 | $79.60 – $210.89 | 1,936 | 6 |
| Smithfield, NC | $91.95 | $49.73 – $98.44 | 1,927 | 2 |
| Bay Shore, NY | $663.54 | $124.92 – $689.44 | 1,918 | 2 |
| Fairfield, OH | $326.75 | $85.17 – $426.94 | 1,918 | 3 |
| Brandon, FL | $209.69 | $25.52 – $284.74 | 1,910 | 6 |
| Dakota Dunes, SD | $98.49 | $91.49 – $117.75 | 1,910 | 4 |
| Rome, NY | $346.31 | $103.80 – $531.51 | 1,903 | 4 |
| Joliet, IL | $171.47 | $93.07 – $194.20 | 1,903 | 4 |
| Englewood Cliffs, NJ | $270.85 | $85.13 – $333.20 | 1,897 | 4 |
| Middlesboro, KY | $306.41 | $306.41 – $306.41 | 1,896 | 1 |
| Metairie, LA | $109.64 | $103.91 – $171.00 | 1,886 | 7 |
| Dover, DE | $136.76 | $41.40 – $272.21 | 1,881 | 7 |
| Lumberton, NJ | $356.88 | $356.88 – $356.88 | 1,881 | 1 |
| Summit, NJ | $750.96 | $96.31 – $861.92 | 1,862 | 3 |
| Frankfort, KY | $270.89 | $78.92 – $288.95 | 1,861 | 2 |
| Harvey, IL | $179.36 | $179.36 – $179.36 | 1,861 | 1 |
| Yardley, PA | $90.20 | $90.20 – $90.20 | 1,858 | 1 |
| Casa Grande, AZ | $228.65 | $219.00 – $274.16 | 1,852 | 2 |
| Clackamas, OR | $451.27 | $74.35 – $461.72 | 1,846 | 3 |
| Cortland, NY | $359.13 | $101.76 – $531.16 | 1,845 | 4 |
| Midlothian, VA | $437.51 | $437.51 – $437.51 | 1,844 | 1 |
| St George, UT | $82.89 | $47.37 – $179.38 | 1,841 | 8 |
| Princeton, IL | $149.57 | $149.57 – $149.57 | 1,839 | 1 |
| Fairbanks, AK | $451.51 | $211.39 – $458.19 | 1,839 | 3 |
| Nampa, ID | $187.39 | $82.69 – $219.13 | 1,831 | 5 |
| Vineland, NJ | $1,015 | $96.65 – $1,591 | 1,829 | 5 |
| Woonsocket, RI | $90.12 | $89.84 – $105.75 | 1,810 | 2 |
| Oneida, NY | $345.15 | $93.30 – $499.04 | 1,806 | 2 |
| Oswego, NY | $532.04 | $84.56 – $818.77 | 1,801 | 5 |
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.