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 |
|---|---|---|---|---|
| Belmont, NC | $179.79 | $179.79 – $179.79 | 153 | 1 |
| Douglaston, NY | $134.08 | $132.48 – $141.89 | 153 | 2 |
| Stoneham, MA | $53.56 | $52.82 – $57.37 | 152 | 4 |
| Manalapan, NJ | $139.57 | $139.57 – $139.57 | 151 | 1 |
| Berea, KY | $180.70 | $96.93 – $552.35 | 150 | 3 |
| Clovis, CA | $3.20 | $3.20 – $3.20 | 149 | 1 |
| Elizabeth City, NC | $124.84 | $70.36 – $360.31 | 149 | 2 |
| Acton, MA | $225.86 | $225.86 – $225.86 | 149 | 1 |
| Rhinebeck, NY | $740.30 | $142.92 – $802.72 | 148 | 2 |
| Diamond Bar, CA | $30.50 | $2.85 – $45.48 | 148 | 2 |
| Middle Village, NY | $125.59 | $125.59 – $125.59 | 147 | 1 |
| Monticello, KY | $138.46 | $84.03 – $655.45 | 147 | 2 |
| Cotto Laurel, PR | $116.76 | $116.76 – $116.76 | 147 | 1 |
| West Plains, MO | $380.87 | $363.03 – $385.68 | 146 | 2 |
| Vicksburg, MS | $113.98 | $61.00 – $160.38 | 146 | 3 |
| Lynwood, CA | $31.48 | $31.48 – $31.48 | 142 | 1 |
| Wilmette, IL | $172.19 | $118.12 – $178.58 | 142 | 2 |
| Rocky Mount, VA | $406.37 | $406.37 – $406.37 | 141 | 1 |
| Cheektowaga, NY | $507.44 | $62.43 – $599.52 | 140 | 2 |
| Carmichael, CA | $135.28 | $21.97 – $394.33 | 140 | 4 |
| St Cloud, MN | $297.56 | $288.58 – $372.34 | 140 | 2 |
| Goshen, NY | $296.67 | $292.77 – $306.67 | 139 | 2 |
| Winslow, AZ | $840.31 | $118.47 – $908.51 | 139 | 2 |
| Lake Havasu City, AZ | $237.85 | $75.12 – $378.59 | 138 | 2 |
| Asheboro, NC | $480.02 | $30.99 – $640.07 | 137 | 2 |
| Riverhead, NY | $169.67 | $101.73 – $632.66 | 136 | 3 |
| The Villages, FL | $86.75 | $86.75 – $86.75 | 136 | 1 |
| Granite City, IL | $165.49 | $165.49 – $165.49 | 136 | 1 |
| Natchez, MS | $114.02 | $114.02 – $114.02 | 136 | 1 |
| Oxon Hill, MD | $413.66 | $413.66 – $413.66 | 136 | 1 |
| Brooklyn, OH | $145.93 | $145.93 – $145.93 | 136 | 1 |
| Guntersville, AL | $84.95 | $84.95 – $84.95 | 135 | 1 |
| Highland Park, NJ | $125.18 | $125.18 – $125.18 | 135 | 1 |
| Warwick, RI | $112.12 | $68.91 – $127.99 | 134 | 2 |
| St. Louis, MO | $276.18 | $220.13 – $281.69 | 134 | 2 |
| Dover, NJ | $148.63 | $148.63 – $148.63 | 133 | 1 |
| Ashland, OH | $381.17 | $192.77 – $427.39 | 132 | 2 |
| Clinton, MD | $89.88 | $89.88 – $89.88 | 132 | 1 |
| Oregon City, OR | $434.03 | $434.03 – $434.03 | 132 | 1 |
| Zeeland, MI | $379.64 | $379.64 – $379.64 | 131 | 1 |
| Howell, MI | $416.14 | $416.14 – $416.14 | 129 | 1 |
| San Carlos, CA | $208.41 | $208.41 – $208.41 | 128 | 1 |
| Farmington, ME | $290.20 | $290.20 – $290.20 | 127 | 1 |
| Amory, MS | $158.01 | $42.52 – $252.05 | 127 | 2 |
| Escanaba, MI | $462.36 | $334.77 – $476.91 | 127 | 2 |
| Portsmouth, NH | $276.18 | $39.18 – $451.15 | 126 | 4 |
| Texarkana, TX | $113.65 | $113.26 – $114.53 | 126 | 2 |
| Ridgecrest, CA | $91.99 | $75.02 – $101.75 | 126 | 2 |
| Gibson City, IL | $189.37 | $187.32 – $204.46 | 125 | 2 |
| Paris, KY | $304.83 | $304.83 – $304.83 | 124 | 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.