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 |
|---|---|---|---|---|
| Batavia, OH | $185.83 | $112.29 – $410.68 | 1,563 | 3 |
| East Syracuse, NY | $336.93 | $104.16 – $345.11 | 1,562 | 4 |
| Port Angeles, WA | $377.76 | $45.16 – $479.80 | 1,559 | 2 |
| Madison, WV | $260.87 | $66.87 – $380.20 | 1,557 | 2 |
| Oak Hill, WV | $502.26 | $68.57 – $666.95 | 1,553 | 3 |
| Waterford, MI | $130.87 | $54.70 – $174.85 | 1,530 | 2 |
| Berwyn, IL | $161.50 | $161.50 – $161.50 | 1,529 | 1 |
| Norman, OK | $165.34 | $62.62 – $182.60 | 1,527 | 4 |
| Daytona Beach, FL | $123.04 | $68.65 – $133.90 | 1,521 | 3 |
| Leesville, LA | $147.79 | $89.48 – $155.61 | 1,515 | 2 |
| Hamilton, NJ | $791.03 | $209.29 – $1,133 | 1,512 | 5 |
| Houma, LA | $173.91 | $31.35 – $177.60 | 1,510 | 2 |
| Phillipsburg, NJ | $1,265 | $125.19 – $1,338 | 1,505 | 2 |
| Manchester, TN | $148.00 | $148.00 – $148.00 | 1,505 | 1 |
| Aiken, SC | $35.48 | $3.90 – $139.56 | 1,502 | 4 |
| Aurora, IL | $183.25 | $88.40 – $212.57 | 1,499 | 10 |
| Middletown, OH | $232.96 | $121.65 – $247.20 | 1,498 | 3 |
| Putnam, CT | $381.64 | $381.64 – $381.64 | 1,497 | 1 |
| Miamisburg, OH | $308.97 | $132.70 – $526.82 | 1,497 | 3 |
| Hopewell, VA | $499.00 | $499.00 – $499.00 | 1,487 | 1 |
| Lake City, FL | $124.44 | $30.79 – $227.19 | 1,479 | 4 |
| Pottsville, PA | $122.61 | $122.61 – $122.61 | 1,465 | 1 |
| South Plainfield, NJ | $161.45 | $161.45 – $161.45 | 1,463 | 1 |
| Kenner, LA | $223.19 | $101.72 – $285.30 | 1,459 | 4 |
| Humacao, PR | $347.69 | $80.04 – $405.00 | 1,453 | 6 |
| Alton, IL | $181.55 | $93.82 – $202.61 | 1,448 | 4 |
| Murray, UT | $13.35 | $6.78 – $185.98 | 1,447 | 2 |
| Honesdale, PA | $161.03 | $17.77 – $173.62 | 1,443 | 5 |
| Union, NJ | $110.88 | $58.15 – $302.34 | 1,442 | 8 |
| Placerville, CA | $129.89 | $0.00 – $228.32 | 1,442 | 3 |
| Wheeling, WV | $139.28 | $75.70 – $182.11 | 1,441 | 5 |
| Apple Valley, CA | $191.28 | $23.20 – $241.94 | 1,438 | 3 |
| Clinton Twp, MI | $205.15 | $32.11 – $339.48 | 1,437 | 2 |
| Saint Paul, MN | $256.48 | $73.50 – $611.44 | 1,435 | 12 |
| Wooster, OH | $169.72 | $138.27 – $345.24 | 1,428 | 2 |
| Camarillo, CA | $193.34 | $193.34 – $193.34 | 1,425 | 1 |
| Roseburg, OR | $188.68 | $11.35 – $277.92 | 1,419 | 5 |
| Greer, SC | $8.88 | $1.99 – $75.28 | 1,415 | 2 |
| Galax, VA | $312.58 | $56.82 – $349.73 | 1,410 | 3 |
| Paradise, CA | $107.44 | $102.16 – $137.56 | 1,401 | 2 |
| Lancaster, SC | $56.50 | $38.66 – $100.24 | 1,399 | 3 |
| Woodbury, NJ | $290.85 | $284.00 – $1,081 | 1,395 | 2 |
| Elkin, NC | $133.36 | $133.36 – $133.36 | 1,394 | 1 |
| Duluth, MN | $215.02 | $146.83 – $408.21 | 1,393 | 8 |
| Guaynabo, PR | $373.11 | $232.00 – $386.89 | 1,380 | 5 |
| Show Low, AZ | $312.19 | $90.83 – $314.30 | 1,380 | 2 |
| Brownsville, TX | $40.66 | $24.72 – $217.27 | 1,371 | 5 |
| Yorba Linda, CA | $208.98 | $208.98 – $208.98 | 1,367 | 1 |
| Shelby, NC | $71.01 | $62.06 – $146.20 | 1,365 | 3 |
| Weirton, WV | $305.28 | $111.60 – $359.01 | 1,363 | 2 |
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.