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 |
|---|---|---|---|---|
| Highland Hills, OH | $120.14 | $120.14 – $120.14 | 27 | 1 |
| Ranson, WV | $288.77 | $288.77 – $288.77 | 26 | 1 |
| Butler, PA | $120.60 | $120.60 – $120.60 | 26 | 1 |
| Dubuque, IA | $234.87 | $234.87 – $234.87 | 26 | 1 |
| Bellaire, TX | $64.06 | $64.06 – $64.06 | 26 | 1 |
| Mt Pleasant, SC | $0.00 | $0.00 – $0.00 | 26 | 1 |
| Newton, MA | $296.29 | $296.29 – $296.29 | 26 | 1 |
| Fontana, CA | $8.53 | $0.00 – $17.07 | 26 | 2 |
| Chester, SC | $0.00 | $0.00 – $0.00 | 26 | 1 |
| Weston, WV | $1,023 | $1,023 – $1,023 | 26 | 1 |
| Kalkaska, MI | $50.56 | $50.56 – $50.56 | 26 | 1 |
| Grand Forks, ND | $110.96 | $109.56 – $112.16 | 26 | 2 |
| Plains, PA | $172.51 | $172.51 – $172.51 | 26 | 1 |
| Concord Twp, OH | $169.33 | $169.33 – $169.33 | 26 | 1 |
| Kailua, HI | $433.13 | $433.13 – $433.13 | 26 | 1 |
| Hawthorne, NY | $176.75 | $176.75 – $176.75 | 25 | 1 |
| State College, PA | $200.00 | $200.00 – $200.00 | 25 | 1 |
| Wynnewood, PA | $104.67 | $104.67 – $104.67 | 25 | 1 |
| Leawood, KS | $188.09 | $188.09 – $188.09 | 25 | 1 |
| Hempstead, NY | $158.81 | $158.81 – $158.81 | 25 | 1 |
| Pullman, WA | $87.98 | $87.98 – $87.98 | 25 | 1 |
| Montoursville, PA | $127.54 | $127.54 – $127.54 | 25 | 1 |
| Polson, MT | $0.00 | $0.00 – $0.00 | 25 | 1 |
| Syosset, NY | $191.54 | $191.54 – $191.54 | 25 | 1 |
| Lawrence, NY | $277.04 | $277.04 – $277.04 | 25 | 1 |
| Belfast, ME | $29.20 | $29.20 – $29.20 | 25 | 1 |
| Crescent City, CA | $115.97 | $115.97 – $115.97 | 25 | 1 |
| Portsmouth, RI | $95.48 | $95.48 – $95.48 | 25 | 1 |
| Spring Valley, NY | $115.00 | $115.00 – $115.00 | 25 | 1 |
| Hancock, MI | $221.28 | $73.51 – $381.35 | 25 | 2 |
| Laurium, MI | $206.46 | $61.87 – $363.09 | 25 | 2 |
| Chambersburg, PA | $147.18 | $131.23 – $163.13 | 24 | 2 |
| Yreka, CA | $69.03 | $69.03 – $69.03 | 24 | 1 |
| Largo, MD | $57.98 | $57.98 – $57.98 | 24 | 1 |
| Mauston, WI | $172.51 | $172.51 – $172.51 | 24 | 1 |
| Ponca City, OK | $221.10 | $221.10 – $221.10 | 24 | 1 |
| Poulsbo, WA | $54.06 | $54.06 – $54.06 | 24 | 1 |
| Flourtown, PA | $132.52 | $132.52 – $132.52 | 24 | 1 |
| Pleasanton, CA | $18.42 | $18.42 – $18.42 | 24 | 1 |
| Pittsfield, ME | $9.04 | $9.04 – $9.04 | 24 | 1 |
| Lake Forest, IL | $234.16 | $232.34 – $235.98 | 24 | 2 |
| Sierra Vista, AZ | $443.31 | $443.31 – $443.31 | 24 | 1 |
| Farmingdale, NY | $353.94 | $353.94 – $353.94 | 24 | 1 |
| Vernon, NJ | $117.62 | $117.62 – $117.62 | 24 | 1 |
| Ripley, WV | $138.04 | $138.04 – $138.04 | 23 | 1 |
| Hanover, PA | $62.31 | $62.31 – $62.31 | 22 | 1 |
| Geneva, OH | $381.55 | $381.55 – $381.55 | 22 | 1 |
| Low Moor, VA | $272.21 | $272.21 – $272.21 | 22 | 1 |
| Libby, MT | $0.00 | $0.00 – $0.00 | 22 | 1 |
| The Woodlands, TX | $35.84 | $35.84 – $35.84 | 21 | 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.