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 |
|---|---|---|---|---|
| Hammond, IN | $297.57 | $297.57 – $297.57 | 410 | 1 |
| Reed City, MI | $308.11 | $308.11 – $308.11 | 409 | 1 |
| Safford, AZ | $701.66 | $701.66 – $701.66 | 408 | 1 |
| Exeter, NH | $187.26 | $187.26 – $187.26 | 407 | 1 |
| Kingston, NY | $201.79 | $127.48 – $397.42 | 405 | 5 |
| Park City, UT | $35.39 | $35.39 – $35.39 | 402 | 1 |
| Cumberland, MD | $113.95 | $17.08 – $250.37 | 401 | 5 |
| Bay Saint Louis, MS | $309.26 | $309.26 – $309.26 | 400 | 1 |
| Parma, OH | $368.33 | $368.33 – $368.33 | 397 | 1 |
| Woodridge, IL | $199.78 | $199.78 – $199.78 | 397 | 1 |
| Lafayette, CO | $112.53 | $86.05 – $135.06 | 396 | 5 |
| Wichita Falls, TX | $106.97 | $106.97 – $106.97 | 393 | 1 |
| Burbank, CA | $64.20 | $47.46 – $84.53 | 393 | 3 |
| Greensburg, PA | $103.33 | $84.10 – $123.36 | 392 | 4 |
| Rogers, AR | $154.30 | $154.30 – $154.30 | 392 | 1 |
| Hilo, HI | $286.86 | $254.92 – $464.72 | 390 | 3 |
| West New York, NJ | $95.43 | $67.60 – $134.20 | 389 | 3 |
| Mount Holly, NJ | $1,193 | $1,193 – $1,193 | 389 | 1 |
| Westland, MI | $191.80 | $191.80 – $191.80 | 389 | 1 |
| Concord, NH | $151.03 | $48.51 – $221.75 | 387 | 5 |
| West Hills, CA | $80.62 | $80.62 – $80.62 | 387 | 1 |
| Newburyport, MA | $100.27 | $60.38 – $591.42 | 386 | 2 |
| Williamsport, IN | $175.52 | $175.52 – $175.52 | 385 | 1 |
| Shawnee, KS | $139.63 | $119.82 – $282.01 | 382 | 4 |
| Safety Harbor, FL | $120.08 | $120.08 – $120.08 | 381 | 1 |
| Independence, MO | $108.97 | $2.14 – $153.29 | 380 | 3 |
| Rome, GA | $77.30 | $67.33 – $83.85 | 380 | 3 |
| Taunton, MA | $191.27 | $65.35 – $611.96 | 380 | 5 |
| Port Charlotte, FL | $149.69 | $126.12 – $172.76 | 378 | 2 |
| Las Piedras, PR | $264.71 | $264.71 – $264.71 | 375 | 1 |
| Cranston, RI | $149.14 | $141.88 – $164.07 | 374 | 3 |
| Roswell, GA | $270.47 | $270.47 – $270.47 | 373 | 1 |
| Alpena, MI | $322.18 | $322.18 – $322.18 | 372 | 1 |
| Gadsden, AL | $141.41 | $87.60 – $154.63 | 371 | 3 |
| Paragould, AR | $205.48 | $205.48 – $205.48 | 368 | 1 |
| Los Banos, CA | $66.31 | $64.42 – $83.76 | 368 | 2 |
| Travis Afb, CA | $306.87 | $306.87 – $306.87 | 367 | 1 |
| Hillsboro, OH | $453.17 | $453.17 – $453.17 | 366 | 1 |
| Clermont, FL | $45.51 | $33.38 – $53.50 | 365 | 4 |
| Winter Haven, FL | $207.66 | $207.66 – $207.66 | 365 | 1 |
| Wharton, TX | $41.73 | $41.73 – $41.73 | 365 | 1 |
| Warsaw, IN | $467.42 | $212.00 – $487.89 | 364 | 2 |
| Midlothian, TX | $154.61 | $154.61 – $154.61 | 363 | 1 |
| Foothill Ranch, CA | $277.56 | $277.56 – $277.56 | 363 | 1 |
| Temple, TX | $245.49 | $52.74 – $342.48 | 362 | 5 |
| Americus, GA | $467.18 | $467.18 – $467.18 | 362 | 1 |
| Inkster, MI | $70.51 | $70.51 – $70.51 | 362 | 1 |
| Elmira, NY | $525.80 | $122.23 – $539.68 | 361 | 2 |
| Milton, MA | $835.45 | $835.45 – $835.45 | 358 | 1 |
| Elma, WA | $641.72 | $334.75 – $787.00 | 358 | 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.