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 |
|---|---|---|---|---|
| Springdale, AR | $218.42 | $158.66 – $289.54 | 838 | 3 |
| Newark, OH | $301.57 | $67.15 – $421.48 | 836 | 3 |
| Martinsville, VA | $424.70 | $32.44 – $573.46 | 834 | 4 |
| La Follette, TN | $116.43 | $116.43 – $116.43 | 832 | 1 |
| San Ramon, CA | $50.97 | $50.97 – $50.97 | 830 | 1 |
| Vincennes, IN | $121.87 | $78.87 – $159.68 | 827 | 2 |
| Long Branch, NJ | $1,810 | $1,810 – $1,810 | 825 | 1 |
| Sonoma, CA | $354.41 | $89.09 – $379.43 | 824 | 2 |
| Bloomfield, CT | $59.47 | $3.08 – $93.65 | 816 | 4 |
| Sandusky, OH | $305.08 | $172.37 – $345.31 | 814 | 4 |
| Hampton, VA | $214.71 | $91.90 – $396.02 | 813 | 5 |
| Bronxville, NY | $651.11 | $651.11 – $651.11 | 813 | 1 |
| South Weymouth, MA | $438.52 | $57.43 – $833.98 | 811 | 2 |
| Temple City, CA | $68.08 | $66.56 – $75.18 | 811 | 2 |
| New Hartford, NY | $82.45 | $82.45 – $82.45 | 806 | 1 |
| Center Valley, PA | $183.69 | $126.33 – $205.40 | 805 | 4 |
| Evanston, IL | $172.46 | $85.03 – $243.54 | 803 | 10 |
| Long Island City, NY | $593.63 | $593.63 – $593.63 | 803 | 1 |
| Bloomington, IL | $177.32 | $177.32 – $177.32 | 799 | 1 |
| Vallejo, CA | $2.21 | $0.32 – $125.51 | 797 | 2 |
| Scranton, PA | $87.87 | $63.40 – $204.18 | 797 | 10 |
| Griffin, GA | $59.88 | $57.75 – $97.24 | 797 | 2 |
| Onancock, VA | $294.50 | $68.75 – $497.61 | 796 | 2 |
| Campbellsville, KY | $353.07 | $73.86 – $363.64 | 795 | 2 |
| Portage, MI | $210.55 | $210.55 – $210.55 | 794 | 1 |
| Logan, UT | $22.43 | $4.42 – $124.96 | 793 | 3 |
| Atlantis, FL | $34.25 | $26.74 – $81.32 | 792 | 4 |
| Salem, NH | $56.21 | $48.44 – $207.17 | 787 | 3 |
| Saratoga Springs, NY | $578.60 | $578.60 – $578.60 | 786 | 1 |
| Apopka, FL | $21.08 | $0.00 – $45.14 | 785 | 3 |
| Watertown, NY | $855.83 | $70.15 – $882.78 | 784 | 2 |
| Frisco, TX | $189.84 | $189.84 – $189.84 | 784 | 1 |
| Newberg, OR | $551.06 | $551.06 – $551.06 | 783 | 1 |
| Washington, PA | $117.66 | $90.02 – $177.21 | 782 | 4 |
| Annapolis, MD | $178.66 | $9.88 – $203.60 | 779 | 5 |
| Hudson, NY | $513.17 | $513.17 – $513.17 | 777 | 1 |
| Hazel Crest, IL | $169.47 | $153.38 – $234.02 | 775 | 4 |
| Moca, PR | $106.72 | $97.24 – $120.39 | 774 | 2 |
| Tarzana, CA | $20.97 | $16.72 – $27.49 | 770 | 5 |
| Augusta, GA | $47.92 | $0.00 – $235.10 | 766 | 5 |
| Sleepy Hollow, NY | $662.05 | $662.05 – $662.05 | 766 | 1 |
| Maysville, KY | $93.86 | $76.59 – $303.52 | 762 | 2 |
| Smyrna, TN | $177.47 | $133.10 – $204.29 | 761 | 3 |
| Littleton, CO | $272.43 | $132.53 – $292.14 | 753 | 2 |
| Carlsbad, NM | $256.53 | $131.30 – $327.23 | 753 | 3 |
| Rocky Mount, NC | $46.24 | $36.27 – $104.61 | 749 | 3 |
| Hamlet, NC | $70.25 | $53.70 – $70.54 | 747 | 2 |
| Rahway, NJ | $154.40 | $154.40 – $154.40 | 745 | 1 |
| Trenton, MI | $370.33 | $370.33 – $370.33 | 745 | 1 |
| Newport, OR | $117.14 | $117.14 – $117.14 | 744 | 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.