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 |
|---|---|---|---|---|
| Livingston, TN | $143.84 | $143.84 – $143.84 | 215 | 1 |
| Overland Park, KS | $73.53 | $67.77 – $155.83 | 214 | 2 |
| Rosedale, MD | $95.54 | $95.54 – $95.54 | 214 | 1 |
| Orange Park, FL | $94.64 | $94.64 – $94.64 | 212 | 1 |
| Cambridge, OH | $287.89 | $89.98 – $366.01 | 212 | 2 |
| East Setauket, NY | $161.70 | $161.70 – $161.70 | 212 | 1 |
| Nottingham, MD | $76.99 | $70.79 – $177.78 | 207 | 2 |
| Vandalia, IL | $182.66 | $182.66 – $182.66 | 205 | 1 |
| Sault Sainte Marie, MI | $261.08 | $71.23 – $343.39 | 205 | 2 |
| Drexel Hill, PA | $586.21 | $586.21 – $586.21 | 204 | 1 |
| Marysville, OH | $453.53 | $453.53 – $453.53 | 203 | 1 |
| Newport Beach, CA | $37.89 | $18.53 – $162.70 | 201 | 2 |
| Mason City, IA | $160.87 | $89.08 – $260.86 | 201 | 3 |
| Midwest City, OK | $69.35 | $67.47 – $73.27 | 201 | 2 |
| Kyle, SD | $447.76 | $447.76 – $447.76 | 201 | 1 |
| Oakdale, LA | $82.77 | $82.77 – $82.77 | 200 | 1 |
| Germantown, MD | $79.16 | $79.16 – $79.16 | 199 | 1 |
| Bradenton, FL | $127.82 | $9.86 – $336.54 | 199 | 3 |
| Hollywood, FL | $182.43 | $167.63 – $198.41 | 197 | 3 |
| Montebello, CA | $143.88 | $77.61 – $249.39 | 197 | 2 |
| Harris, NY | $544.95 | $104.58 – $608.95 | 197 | 2 |
| Cayey, PR | $92.10 | $92.10 – $92.10 | 196 | 1 |
| Wheaton, MD | $59.15 | $59.15 – $59.15 | 196 | 1 |
| Saint Charles, MO | $154.65 | $154.65 – $154.65 | 195 | 1 |
| Hyattsville, MD | $281.64 | $281.64 – $281.64 | 193 | 1 |
| Sanford, NC | $56.16 | $54.80 – $56.83 | 192 | 2 |
| Hillsdale, MI | $278.35 | $50.77 – $293.52 | 192 | 2 |
| Harrington Park, NJ | $108.91 | $108.91 – $108.91 | 192 | 1 |
| Gautier, MS | $12.58 | $12.58 – $12.58 | 191 | 1 |
| South Williamson, KY | $237.84 | $47.76 – $340.56 | 191 | 3 |
| Milford, MA | $405.29 | $58.23 – $707.89 | 190 | 4 |
| Highland, CA | $91.34 | $91.34 – $91.34 | 190 | 1 |
| Chicopee, MA | $56.19 | $56.19 – $56.19 | 189 | 1 |
| Manassas, VA | $426.21 | $87.32 – $656.28 | 188 | 3 |
| Hinsdale, IL | $190.55 | $186.93 – $197.57 | 188 | 2 |
| Fremont, MI | $424.56 | $424.56 – $424.56 | 188 | 1 |
| Weston, FL | $53.47 | $50.96 – $53.74 | 187 | 2 |
| Rocky Hill, CT | $44.20 | $44.20 – $44.20 | 186 | 1 |
| Bordentown, NJ | $187.41 | $187.41 – $187.41 | 186 | 1 |
| Amarillo, TX | $62.83 | $15.45 – $106.47 | 185 | 3 |
| Kapolei, HI | $185.44 | $177.41 – $232.45 | 185 | 2 |
| Lenoir, NC | $54.69 | $54.69 – $54.69 | 184 | 1 |
| Greenville, KY | $118.04 | $90.40 – $372.89 | 184 | 2 |
| Rutland, VT | $16.02 | $15.94 – $17.22 | 182 | 2 |
| Cary, NC | $57.06 | $33.49 – $82.67 | 182 | 5 |
| Verona, WI | $171.87 | $171.87 – $171.87 | 181 | 1 |
| Niskayana, NY | $627.58 | $627.58 – $627.58 | 181 | 1 |
| Dansville, NY | $660.12 | $660.12 – $660.12 | 180 | 1 |
| Emporia, VA | $179.55 | $51.42 – $344.78 | 180 | 3 |
| Freeport, IL | $171.03 | $171.03 – $171.03 | 179 | 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.