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 |
|---|---|---|---|---|
| Tampa, FL | $148.64 | $16.42 – $382.00 | 11,618 | 31 |
| Colorado Springs, CO | $169.62 | $61.23 – $441.81 | 11,570 | 26 |
| Madisonville, KY | $224.68 | $72.89 – $333.65 | 11,548 | 3 |
| Gulfport, MS | $160.92 | $12.27 – $337.61 | 11,533 | 11 |
| Ocala, FL | $146.91 | $38.73 – $281.58 | 11,451 | 8 |
| Anchorage, AK | $503.28 | $144.51 – $673.85 | 11,223 | 22 |
| Paducah, KY | $185.04 | $69.70 – $310.01 | 11,217 | 10 |
| Fort Wayne, IN | $346.62 | $61.12 – $822.43 | 11,004 | 30 |
| Portland, OR | $323.46 | $41.96 – $592.38 | 10,977 | 43 |
| Harlingen, TX | $105.21 | $0.00 – $350.32 | 10,961 | 10 |
| Astoria, NY | $305.73 | $101.31 – $419.91 | 10,891 | 7 |
| Salt Lake City, UT | $57.89 | $1.66 – $554.60 | 10,862 | 12 |
| Rochester, NY | $657.66 | $96.81 – $796.49 | 10,794 | 30 |
| Dearborn, MI | $170.73 | $44.36 – $358.57 | 10,780 | 8 |
| Springfield, MA | $563.23 | $29.26 – $790.69 | 10,767 | 19 |
| Vancouver, WA | $201.61 | $43.23 – $300.84 | 10,616 | 16 |
| Corona, CA | $158.16 | $43.17 – $266.27 | 10,562 | 7 |
| Madera, CA | $97.28 | $0.91 – $912.70 | 10,469 | 17 |
| North Bergen, NJ | $297.50 | $111.44 – $752.22 | 10,467 | 9 |
| Roswell, NM | $243.35 | $122.82 – $437.14 | 10,447 | 6 |
| Greenville, SC | $32.76 | $0.00 – $217.41 | 10,375 | 29 |
| Denver, CO | $190.73 | $9.10 – $545.68 | 10,325 | 30 |
| Elizabeth, NJ | $309.08 | $72.03 – $449.20 | 10,176 | 4 |
| Santa Ana, CA | $183.55 | $23.29 – $204.86 | 10,099 | 5 |
| Norwich, CT | $149.72 | $31.86 – $364.32 | 10,095 | 8 |
| Turlock, CA | $224.19 | $35.86 – $667.69 | 10,069 | 4 |
| Columbia, SC | $46.73 | $1.15 – $184.56 | 10,022 | 24 |
| Southfield, MI | $62.57 | $40.37 – $65.52 | 9,935 | 7 |
| Scottsdale, AZ | $261.87 | $30.45 – $900.27 | 9,916 | 18 |
| Springfield, OR | $238.56 | $52.20 – $392.84 | 9,860 | 13 |
| Hazard, KY | $257.02 | $63.81 – $377.21 | 9,840 | 6 |
| Zanesville, OH | $178.03 | $113.84 – $260.60 | 9,825 | 5 |
| Madison, WI | $194.90 | $73.80 – $398.87 | 9,665 | 8 |
| San Francisco, CA | $140.26 | $0.40 – $944.87 | 9,561 | 33 |
| Edison, NJ | $518.32 | $1.26 – $799.11 | 9,539 | 12 |
| Salem, OR | $185.06 | $54.24 – $337.03 | 9,497 | 10 |
| Joplin, MO | $200.98 | $124.70 – $235.38 | 9,410 | 5 |
| Oroville, CA | $92.38 | $0.00 – $342.31 | 9,402 | 7 |
| Redding, CA | $166.19 | $23.25 – $302.26 | 9,359 | 13 |
| Wyoming, MI | $145.62 | $42.49 – $185.30 | 9,256 | 4 |
| Fall River, MA | $201.32 | $45.71 – $903.65 | 9,196 | 14 |
| Forest Hills, NY | $203.71 | $69.09 – $347.33 | 9,179 | 12 |
| New Hyde Park, NY | $514.76 | $73.87 – $810.02 | 9,169 | 16 |
| Jacksonville, FL | $150.79 | $28.34 – $434.24 | 9,153 | 21 |
| Van Nuys, CA | $170.73 | $83.87 – $274.35 | 9,152 | 4 |
| Jersey City, NJ | $686.60 | $68.45 – $1,536 | 9,087 | 6 |
| Bangor, ME | $291.76 | $55.61 – $333.65 | 9,025 | 14 |
| Honolulu, HI | $288.21 | $64.24 – $819.67 | 9,000 | 17 |
| Atlanta, GA | $1,042 | $51.90 – $1,412 | 8,990 | 19 |
| Liverpool, NY | $328.97 | $90.71 – $497.04 | 8,955 | 6 |
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.