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 |
|---|---|---|---|---|
| Decatur, IL | $178.03 | $142.58 – $223.55 | 739 | 6 |
| Amsterdam, NY | $447.06 | $111.02 – $544.33 | 735 | 2 |
| S Charleston, WV | $71.77 | $71.77 – $71.77 | 731 | 1 |
| Cerritos, CA | $25.62 | $25.62 – $25.62 | 730 | 1 |
| Cedar Knolls, NJ | $502.28 | $502.28 – $502.28 | 729 | 1 |
| Oxford, NC | $219.01 | $219.01 – $219.01 | 723 | 1 |
| Greenville, MI | $249.90 | $249.90 – $249.90 | 723 | 1 |
| Northbrook, IL | $163.95 | $163.95 – $163.95 | 722 | 1 |
| Largo, FL | $138.79 | $119.61 – $298.73 | 719 | 2 |
| Mount Vernon, OH | $320.86 | $225.07 – $469.83 | 718 | 2 |
| Menasha, WI | $178.68 | $122.00 – $292.36 | 718 | 3 |
| St Augustine, FL | $89.88 | $21.37 – $91.14 | 715 | 2 |
| La Grange, KY | $279.03 | $99.59 – $373.73 | 715 | 2 |
| American Fork, UT | $89.03 | $83.91 – $135.43 | 715 | 4 |
| Macomb, IL | $145.72 | $145.72 – $145.72 | 712 | 1 |
| Daly City, CA | $142.37 | $142.37 – $142.37 | 712 | 1 |
| Muncie, IN | $120.45 | $58.78 – $157.19 | 703 | 5 |
| Newark, NY | $301.60 | $61.59 – $683.32 | 702 | 2 |
| Findlay, OH | $312.04 | $249.64 – $321.15 | 699 | 2 |
| Morris, IL | $140.95 | $95.78 – $159.20 | 694 | 3 |
| North Chelmsford, MA | $56.95 | $42.39 – $61.15 | 688 | 5 |
| Auburn, WA | $169.10 | $51.55 – $311.37 | 683 | 2 |
| Alexander City, AL | $104.46 | $104.46 – $104.46 | 683 | 1 |
| Harrisburg, PA | $216.28 | $103.60 – $242.68 | 679 | 4 |
| Rochester, NH | $412.04 | $123.25 – $466.37 | 679 | 3 |
| Maple Grove, MN | $110.95 | $49.88 – $175.37 | 678 | 7 |
| Temple Terrace, FL | $122.03 | $122.03 – $122.03 | 674 | 1 |
| Sulphur, LA | $152.14 | $149.24 – $197.92 | 672 | 2 |
| Lapeer, MI | $204.71 | $53.34 – $308.93 | 671 | 3 |
| Eureka, CA | $70.26 | $42.56 – $293.37 | 669 | 4 |
| Gastonia, NC | $84.53 | $50.30 – $208.43 | 668 | 8 |
| Newburgh, NY | $820.17 | $86.83 – $903.40 | 667 | 5 |
| Loveland, CO | $106.28 | $18.99 – $171.36 | 667 | 6 |
| Oradell, NJ | $193.24 | $193.24 – $193.24 | 667 | 1 |
| Pleasant Hill, CA | $360.31 | $360.31 – $360.31 | 666 | 1 |
| Seneca, SC | $15.32 | $7.36 – $50.36 | 665 | 3 |
| Woodbridge, VA | $449.79 | $267.86 – $566.96 | 660 | 4 |
| San Leandro, CA | $476.16 | $161.36 – $743.80 | 659 | 3 |
| West Monroe, LA | $94.16 | $94.16 – $94.16 | 659 | 1 |
| Trujillo Alro, PR | $268.67 | $268.67 – $268.67 | 659 | 1 |
| Beverly, MA | $630.48 | $60.99 – $692.44 | 658 | 3 |
| North Chesterfield, VA | $61.97 | $48.11 – $68.39 | 656 | 7 |
| Montgomery, AL | $84.78 | $35.18 – $566.04 | 654 | 4 |
| Ravenna, OH | $351.36 | $71.85 – $376.37 | 654 | 3 |
| Grove City, OH | $212.97 | $207.78 – $221.74 | 648 | 2 |
| Englewood, CO | $129.00 | $91.54 – $141.65 | 640 | 3 |
| Wauwatosa, WI | $106.53 | $106.53 – $106.53 | 639 | 1 |
| Kirkland, WA | $14.10 | $7.46 – $360.91 | 639 | 2 |
| East Orange, NJ | $474.36 | $474.36 – $474.36 | 637 | 1 |
| Laredo, TX | $58.01 | $16.77 – $214.82 | 629 | 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.