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 |
|---|---|---|---|---|
| Troy, AL | $87.44 | $87.44 – $87.44 | 51 | 1 |
| Lafayette, CA | $20.90 | $20.90 – $20.90 | 51 | 1 |
| Shadyside, PA | $135.08 | $135.08 – $135.08 | 51 | 1 |
| Long Beach, NY | $166.72 | $166.72 – $166.72 | 50 | 1 |
| Burlington, VT | $232.76 | $43.79 – $398.73 | 50 | 3 |
| North Dartmouth, MA | $61.63 | $59.97 – $62.15 | 50 | 2 |
| London, OH | $358.37 | $358.37 – $358.37 | 50 | 1 |
| Morgan City, LA | $55.49 | $55.49 – $55.49 | 50 | 1 |
| Columbus, NC | $182.30 | $182.30 – $182.30 | 50 | 1 |
| Fort Lewis, WA | $59.45 | $59.45 – $59.45 | 50 | 1 |
| Tulare, CA | $46.44 | $46.44 – $46.44 | 49 | 1 |
| St Louis Park, MN | $80.54 | $66.10 – $94.40 | 49 | 2 |
| Kingston, PA | $422.39 | $422.39 – $422.39 | 49 | 1 |
| Snellville, GA | $157.40 | $157.40 – $157.40 | 49 | 1 |
| Louisville, CO | $132.20 | $132.20 – $132.20 | 48 | 1 |
| Weston, WI | $114.28 | $114.28 – $114.28 | 48 | 1 |
| Cynthiana, KY | $423.21 | $423.21 – $423.21 | 47 | 1 |
| Greenwich, CT | $557.11 | $557.11 – $557.11 | 47 | 1 |
| Bentonville, AR | $171.36 | $171.36 – $171.36 | 47 | 1 |
| Bridgeton, MO | $113.81 | $113.81 – $113.81 | 46 | 1 |
| Westminster, MD | $83.64 | $76.82 – $86.62 | 46 | 2 |
| Fruita, CO | $324.45 | $324.45 – $324.45 | 46 | 1 |
| Leonardtown, MD | $64.57 | $64.57 – $64.57 | 46 | 1 |
| Clifton Springs, NY | $243.72 | $75.91 – $719.17 | 46 | 2 |
| Winchester, TN | $100.66 | $59.79 – $121.09 | 45 | 2 |
| Springfield, VA | $133.92 | $133.92 – $133.92 | 45 | 1 |
| Zillah, WA | $44.34 | $44.34 – $44.34 | 45 | 1 |
| Lauderdale Lakes, FL | $117.78 | $117.78 – $117.78 | 44 | 1 |
| Templeton, CA | $64.92 | $42.64 – $91.66 | 44 | 2 |
| Somerville, NJ | $401.07 | $401.07 – $401.07 | 44 | 1 |
| Lancaster, WI | $167.35 | $167.35 – $167.35 | 44 | 1 |
| Gulf Breeze, FL | $28.82 | $28.82 – $28.82 | 44 | 1 |
| Kernersville, NC | $234.21 | $234.21 – $234.21 | 44 | 1 |
| Somerset, NJ | $110.20 | $103.28 – $115.19 | 43 | 2 |
| Novato, CA | $138.06 | $138.06 – $138.06 | 43 | 1 |
| Georgetown, DE | $1,110 | $1,110 – $1,110 | 43 | 1 |
| Espanola, NM | $308.19 | $116.13 – $382.54 | 43 | 2 |
| Lawrenceville, GA | $63.83 | $63.83 – $63.83 | 43 | 1 |
| Cleveland Heights, OH | $166.75 | $166.75 – $166.75 | 43 | 1 |
| Dillon, SC | $25.14 | $0.00 – $36.03 | 43 | 2 |
| Manhattan, KS | $69.37 | $64.54 – $72.05 | 42 | 2 |
| Anacortes, WA | $46.69 | $46.69 – $46.69 | 42 | 1 |
| Wise, VA | $68.02 | $68.02 – $68.02 | 42 | 1 |
| East Providence, RI | $323.92 | $276.40 – $350.32 | 42 | 2 |
| Tuba City, AZ | $254.29 | $254.29 – $254.29 | 42 | 1 |
| Los Gatos, CA | $315.69 | $315.69 – $315.69 | 41 | 1 |
| Clyde, NC | $57.88 | $57.88 – $57.88 | 41 | 1 |
| Lakeport, CA | $204.39 | $204.39 – $204.39 | 41 | 1 |
| Ahoskie, NC | $31.79 | $31.79 – $31.79 | 41 | 1 |
| Folsom, CA | $36.56 | $36.56 – $36.56 | 41 | 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.