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 |
|---|---|---|---|---|
| Woodburn, OR | $566.05 | $566.05 – $566.05 | 1,801 | 1 |
| Wyomissing, PA | $108.35 | $1.53 – $184.31 | 1,798 | 13 |
| Erie, PA | $130.08 | $76.60 – $225.19 | 1,791 | 13 |
| Salem, MA | $133.02 | $48.61 – $242.12 | 1,787 | 11 |
| West Columbia, SC | $99.49 | $8.99 – $209.45 | 1,778 | 6 |
| Hendersonville, NC | $120.81 | $13.61 – $224.61 | 1,773 | 7 |
| Statesville, NC | $104.49 | $43.61 – $171.48 | 1,768 | 6 |
| Danville, PA | $188.26 | $51.04 – $262.35 | 1,757 | 22 |
| Abilene, TX | $129.14 | $38.77 – $327.78 | 1,757 | 3 |
| Vadnais Heights, MN | $410.62 | $410.62 – $410.62 | 1,747 | 1 |
| Sayre, PA | $345.61 | $80.95 – $519.64 | 1,736 | 7 |
| Fort Pierce, FL | $131.07 | $43.13 – $181.50 | 1,728 | 4 |
| Guayama, PR | $278.05 | $277.26 – $294.81 | 1,725 | 2 |
| Bloomington, IN | $494.05 | $83.03 – $561.23 | 1,721 | 6 |
| Auburn, CA | $48.90 | $48.90 – $48.90 | 1,711 | 1 |
| Brockton, MA | $571.96 | $52.00 – $1,020 | 1,706 | 11 |
| Crowley, LA | $136.06 | $136.06 – $136.06 | 1,702 | 1 |
| Gig Harbor, WA | $178.10 | $51.37 – $317.33 | 1,693 | 3 |
| Wyandotte, MI | $291.85 | $71.56 – $361.05 | 1,684 | 4 |
| Huber Heights, OH | $174.87 | $89.72 – $216.46 | 1,682 | 2 |
| Bristol, TN | $134.89 | $43.24 – $401.76 | 1,669 | 8 |
| Raleigh, NC | $127.06 | $45.73 – $212.41 | 1,665 | 16 |
| Walla Walla, WA | $163.85 | $39.43 – $280.73 | 1,665 | 5 |
| Burbank, IL | $170.19 | $170.19 – $170.19 | 1,663 | 1 |
| Terre Haute, IN | $146.10 | $0.00 – $422.15 | 1,661 | 9 |
| Muskogee, OK | $209.89 | $136.70 – $285.94 | 1,659 | 4 |
| Torrington, CT | $106.71 | $45.57 – $274.63 | 1,659 | 7 |
| Lewiston, ID | $108.31 | $67.75 – $214.83 | 1,647 | 4 |
| Chino Hills, CA | $220.64 | $0.00 – $293.23 | 1,644 | 2 |
| Bozeman, MT | $103.11 | $69.26 – $250.82 | 1,636 | 5 |
| Northglenn, CO | $120.90 | $109.55 – $125.31 | 1,634 | 3 |
| Moses Lake, WA | $65.95 | $33.57 – $322.05 | 1,633 | 5 |
| Silverdale, WA | $172.23 | $43.77 – $253.14 | 1,624 | 5 |
| Farmington, MI | $58.62 | $58.62 – $58.62 | 1,613 | 1 |
| Alamogordo, NM | $308.32 | $266.58 – $333.70 | 1,610 | 3 |
| Woodland Park, NJ | $605.96 | $143.40 – $675.54 | 1,606 | 4 |
| Fort Lee, NJ | $85.69 | $85.29 – $130.80 | 1,601 | 2 |
| Pearl City, HI | $389.32 | $389.32 – $389.32 | 1,598 | 1 |
| Highland, IN | $551.82 | $551.82 – $551.82 | 1,595 | 1 |
| East Meadow, NY | $221.02 | $33.26 – $605.48 | 1,595 | 4 |
| West Jordan, UT | $179.06 | $0.00 – $198.35 | 1,594 | 3 |
| Port Jefferson Station, NY | $463.09 | $463.09 – $463.09 | 1,588 | 1 |
| Angeles, PR | $309.95 | $309.95 – $309.95 | 1,588 | 1 |
| Gallatin, TN | $161.87 | $64.90 – $182.81 | 1,582 | 2 |
| Westbury, NY | $449.08 | $449.08 – $449.08 | 1,580 | 1 |
| Dothan, AL | $70.07 | $6.63 – $127.82 | 1,575 | 7 |
| Saint Helena, CA | $174.00 | $71.12 – $196.83 | 1,575 | 2 |
| Fairview Heights, IL | $193.73 | $83.63 – $194.64 | 1,573 | 2 |
| Athens, OH | $248.46 | $245.57 – $353.87 | 1,572 | 2 |
| Tempe, AZ | $368.46 | $368.46 – $368.46 | 1,566 | 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.