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 |
|---|---|---|---|---|
| Aibonito, PR | $344.40 | $342.84 – $405.00 | 478 | 2 |
| Chardon, OH | $425.14 | $425.14 – $425.14 | 477 | 1 |
| Hastings, MI | $341.58 | $64.03 – $449.84 | 474 | 2 |
| Plattsburgh, NY | $537.52 | $537.52 – $537.52 | 473 | 1 |
| Cuyahoga Falls, OH | $277.87 | $231.72 – $433.82 | 473 | 2 |
| Odessa, FL | $365.00 | $365.00 – $365.00 | 471 | 1 |
| Kettering, OH | $249.53 | $249.53 – $249.53 | 469 | 1 |
| Boulder, CO | $173.72 | $114.95 – $220.29 | 467 | 3 |
| Harrisburg, IL | $151.68 | $151.68 – $151.68 | 466 | 1 |
| Sandy, UT | $150.84 | $0.00 – $176.48 | 465 | 3 |
| Mchenry, IL | $216.88 | $152.24 – $294.70 | 465 | 2 |
| Lockport, NY | $414.62 | $414.62 – $414.62 | 462 | 1 |
| Ontario, CA | $217.62 | $138.15 – $336.50 | 461 | 3 |
| Chester, VA | $66.18 | $66.18 – $66.18 | 461 | 1 |
| Sterling, IL | $161.07 | $161.07 – $161.07 | 460 | 1 |
| Weslaco, TX | $43.07 | $43.07 – $43.07 | 458 | 1 |
| Gaylord, MI | $172.60 | $49.92 – $300.20 | 457 | 2 |
| Oro Valley, AZ | $248.06 | $83.06 – $338.72 | 454 | 2 |
| Amherst, NY | $379.40 | $97.21 – $509.99 | 452 | 2 |
| San Gabriel, CA | $69.01 | $65.84 – $73.49 | 449 | 2 |
| Williamsburg, VA | $425.48 | $63.70 – $702.38 | 448 | 5 |
| Stafford, VA | $609.75 | $609.75 – $609.75 | 447 | 1 |
| Mechanicsburg, PA | $62.58 | $61.33 – $104.33 | 446 | 2 |
| Jacksonville Beach, FL | $40.80 | $40.80 – $40.80 | 446 | 1 |
| Globe, AZ | $690.65 | $93.78 – $908.52 | 445 | 2 |
| Hot Springs, AR | $166.47 | $160.89 – $219.41 | 443 | 5 |
| Palm Coast, FL | $41.05 | $41.05 – $41.05 | 443 | 1 |
| Beverly Hills, CA | $67.86 | $5.25 – $360.00 | 442 | 8 |
| San Luis Obispo, CA | $159.66 | $86.59 – $183.99 | 441 | 4 |
| Corpus Christi, TX | $622.91 | $92.36 – $3,068 | 438 | 4 |
| Saranac Lake, NY | $548.37 | $86.13 – $676.40 | 438 | 2 |
| Wexford, PA | $68.12 | $48.72 – $68.66 | 437 | 2 |
| Freehold, NJ | $785.61 | $785.61 – $785.61 | 435 | 1 |
| Cudahy, WI | $180.06 | $130.80 – $186.28 | 435 | 3 |
| Ridgefield, CT | $110.49 | $110.49 – $110.49 | 434 | 1 |
| Dixon, IL | $147.91 | $147.91 – $147.91 | 434 | 1 |
| Decatur, GA | $194.60 | $126.59 – $218.84 | 434 | 3 |
| Homewood, IL | $191.79 | $184.44 – $193.92 | 427 | 2 |
| Palm Bay, FL | $187.58 | $51.82 – $238.56 | 426 | 3 |
| Orange, NJ | $140.36 | $140.36 – $140.36 | 424 | 1 |
| Pine Ridge, SD | $395.28 | $395.28 – $395.28 | 424 | 1 |
| Banning, CA | $79.78 | $11.73 – $182.06 | 423 | 2 |
| Hillsborough, NJ | $248.46 | $133.32 – $252.12 | 422 | 2 |
| Tallahassee, FL | $56.53 | $54.44 – $56.60 | 419 | 2 |
| Kahului, HI | $231.35 | $68.95 – $261.49 | 417 | 3 |
| Sumter, SC | $26.97 | $13.00 – $192.74 | 416 | 5 |
| Waterford, CT | $62.18 | $62.18 – $62.18 | 415 | 1 |
| Meridian, ID | $155.48 | $83.48 – $219.65 | 412 | 5 |
| Skowhegan, ME | $78.72 | $48.48 – $212.45 | 412 | 3 |
| Barrington, IL | $174.64 | $160.29 – $208.62 | 411 | 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.