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 |
|---|---|---|---|---|
| Ansonia, CT | $56.25 | $54.76 – $65.53 | 1,209 | 3 |
| Leesburg, VA | $83.89 | $62.97 – $414.74 | 1,208 | 7 |
| Supply, NC | $63.82 | $50.77 – $78.10 | 1,208 | 3 |
| Cameron Park, CA | $159.36 | $137.35 – $183.85 | 1,207 | 3 |
| Somersworth, NH | $53.52 | $45.50 – $66.90 | 1,203 | 4 |
| Greenbelt, MD | $70.13 | $47.00 – $84.10 | 1,203 | 4 |
| Hoboken, NJ | $472.62 | $64.90 – $716.50 | 1,198 | 3 |
| Oshkosh, WI | $190.72 | $55.62 – $204.53 | 1,190 | 5 |
| Rockford, IL | $171.37 | $144.90 – $420.16 | 1,188 | 15 |
| Sierra Madre, CA | $145.36 | $145.36 – $145.36 | 1,188 | 1 |
| Hyannis, MA | $234.89 | $234.89 – $234.89 | 1,187 | 1 |
| Levittown, PA | $262.20 | $235.96 – $517.24 | 1,183 | 3 |
| Somers Point, NJ | $313.71 | $189.79 – $1,292 | 1,181 | 5 |
| Glen Burnie, MD | $182.92 | $38.50 – $192.36 | 1,179 | 3 |
| Plantation, FL | $80.93 | $29.50 – $217.91 | 1,177 | 6 |
| Wisconsin Rapids, WI | $134.83 | $89.34 – $156.88 | 1,176 | 2 |
| Denison, TX | $197.31 | $100.84 – $200.63 | 1,174 | 2 |
| Irvington, NJ | $96.24 | $96.24 – $96.24 | 1,170 | 1 |
| Bellevue, WA | $131.59 | $104.42 – $288.70 | 1,169 | 3 |
| Jonesboro, AR | $118.11 | $76.68 – $134.93 | 1,167 | 4 |
| Oakbrook Terrace, IL | $154.18 | $149.63 – $220.92 | 1,167 | 3 |
| Tolland, CT | $45.93 | $45.93 – $45.93 | 1,166 | 1 |
| Huntington Park, CA | $138.47 | $138.47 – $138.47 | 1,166 | 1 |
| Walnut, CA | $99.90 | $99.90 – $99.90 | 1,162 | 1 |
| Pequannock, NJ | $181.53 | $181.53 – $181.53 | 1,154 | 1 |
| Fairborn, OH | $70.44 | $70.44 – $70.44 | 1,148 | 1 |
| E Patchogue, NY | $110.87 | $109.67 – $120.55 | 1,148 | 4 |
| Greenfield, WI | $140.12 | $140.12 – $140.12 | 1,146 | 1 |
| Mount Pleasant, MI | $61.13 | $61.13 – $61.13 | 1,138 | 1 |
| Duncan, OK | $162.52 | $162.52 – $162.52 | 1,137 | 1 |
| West Corina, CA | $105.31 | $105.31 – $105.31 | 1,135 | 1 |
| Pinellas Park, FL | $44.78 | $22.90 – $46.67 | 1,133 | 4 |
| Fullerton, CA | $15.74 | $15.74 – $15.74 | 1,131 | 1 |
| Santa Rosa Beach, FL | $82.21 | $80.27 – $101.24 | 1,123 | 2 |
| West Bridgewater, MA | $215.77 | $215.77 – $215.77 | 1,109 | 1 |
| Spring Hill, FL | $232.01 | $232.01 – $232.01 | 1,108 | 1 |
| Brunswick, ME | $280.56 | $58.27 – $301.42 | 1,098 | 3 |
| Dartmouth, MA | $57.79 | $35.08 – $66.42 | 1,097 | 4 |
| Southbridge, MA | $863.36 | $863.36 – $863.36 | 1,092 | 1 |
| Alexandria, LA | $69.35 | $17.94 – $266.78 | 1,089 | 5 |
| Shenandoah, TX | $212.13 | $85.39 – $214.82 | 1,085 | 3 |
| East Stroudsburg, PA | $129.55 | $120.32 – $170.92 | 1,082 | 3 |
| Martinsburg, WV | $144.11 | $65.30 – $356.16 | 1,081 | 4 |
| Babylon, NY | $104.49 | $90.25 – $108.32 | 1,081 | 3 |
| Geneva, NY | $327.03 | $113.56 – $417.96 | 1,078 | 2 |
| Lewes, DE | $133.56 | $3.77 – $185.46 | 1,077 | 3 |
| Hollywood, MD | $22.74 | $22.09 – $68.36 | 1,077 | 2 |
| Angola, IN | $761.41 | $530.80 – $772.19 | 1,075 | 2 |
| Franklin, WI | $198.69 | $184.95 – $199.87 | 1,074 | 2 |
| Whittier, CA | $146.89 | $54.68 – $188.33 | 1,074 | 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.