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 |
|---|---|---|---|---|
| Orland Park, IL | $124.30 | $97.89 – $141.15 | 77 | 2 |
| Pompano Beach, FL | $68.23 | $68.23 – $68.23 | 76 | 1 |
| Roseville, CA | $67.06 | $0.00 – $185.30 | 76 | 6 |
| Pasadena, CA | $24.84 | $0.00 – $29.96 | 76 | 2 |
| Ashland, WI | $416.67 | $360.56 – $585.01 | 76 | 2 |
| Broomfield, CO | $206.42 | $206.42 – $206.42 | 76 | 1 |
| Myrtle Beach, SC | $143.97 | $143.97 – $143.97 | 75 | 1 |
| Sonora, CA | $80.31 | $80.31 – $80.31 | 75 | 1 |
| Roanoke Rapids, NC | $153.48 | $113.80 – $232.84 | 75 | 2 |
| New Milford, CT | $234.99 | $35.32 – $363.85 | 75 | 3 |
| Hutchinson, KS | $124.88 | $105.29 – $158.97 | 74 | 2 |
| Sidney, OH | $274.10 | $274.10 – $274.10 | 74 | 1 |
| Lake Success, NY | $73.72 | $73.72 – $73.72 | 73 | 1 |
| Reedley, CA | $62.10 | $0.00 – $75.56 | 73 | 2 |
| Artesia, NM | $51.01 | $51.01 – $51.01 | 73 | 1 |
| Irvine, KY | $151.11 | $37.74 – $296.37 | 73 | 2 |
| Marion, VA | $323.45 | $323.45 – $323.45 | 72 | 1 |
| Opelousas, LA | $105.92 | $104.72 – $110.78 | 71 | 2 |
| Wellesley, MA | $108.03 | $108.03 – $108.03 | 71 | 1 |
| Thousand Oaks, CA | $66.26 | $66.26 – $66.26 | 70 | 1 |
| Walterboro, SC | $85.52 | $85.52 – $85.52 | 70 | 1 |
| Johns Creek, GA | $187.45 | $187.45 – $187.45 | 70 | 1 |
| Medina, OH | $377.37 | $359.89 – $387.31 | 69 | 2 |
| Pottstown, PA | $150.98 | $150.98 – $150.98 | 69 | 1 |
| Uniondale, NY | $547.31 | $547.31 – $547.31 | 68 | 1 |
| Macomb, MI | $184.11 | $184.11 – $184.11 | 68 | 1 |
| Thomasville, GA | $146.13 | $81.86 – $161.31 | 68 | 2 |
| Somerset, PA | $143.59 | $119.48 – $234.84 | 67 | 2 |
| Lutz, FL | $47.86 | $20.20 – $58.81 | 67 | 2 |
| Amherst, MA | $196.38 | $196.38 – $196.38 | 67 | 1 |
| Grayslake, IL | $217.98 | $135.10 – $236.40 | 66 | 2 |
| Brainerd, MN | $444.18 | $400.32 – $641.54 | 66 | 2 |
| Salem, UT | $97.25 | $97.25 – $97.25 | 66 | 1 |
| Palmer, MA | $969.51 | $969.51 – $969.51 | 65 | 1 |
| San Angelo, TX | $34.12 | $34.12 – $34.12 | 65 | 1 |
| Big Rapids, MI | $147.07 | $147.07 – $147.07 | 65 | 1 |
| Kennebunk, ME | $89.54 | $89.54 – $89.54 | 64 | 1 |
| Media, PA | $217.77 | $217.77 – $217.77 | 64 | 1 |
| Valdosta, GA | $39.44 | $39.44 – $39.44 | 64 | 1 |
| Lancaster, PA | $124.86 | $117.11 – $126.68 | 63 | 2 |
| Arlington, TX | $132.88 | $5.79 – $165.92 | 63 | 2 |
| Ft Myers, FL | $0.00 | $0.00 – $0.00 | 63 | 1 |
| Riverdale, NJ | $204.07 | $166.48 – $363.82 | 63 | 2 |
| Sitka, AK | $587.32 | $587.32 – $587.32 | 62 | 1 |
| Hazleton, PA | $129.68 | $129.68 – $129.68 | 61 | 1 |
| Ware, MA | $42.00 | $42.00 – $42.00 | 61 | 1 |
| Natchitoches, LA | $144.45 | $117.94 – $152.51 | 60 | 2 |
| Hamburg, NY | $426.99 | $426.99 – $426.99 | 59 | 1 |
| Post Falls, ID | $178.58 | $70.55 – $290.33 | 59 | 2 |
| Henderson, NC | $58.88 | $43.22 – $64.71 | 59 | 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.