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 |
|---|---|---|---|---|
| Tipton, IN | $40.35 | $40.35 – $40.35 | 21 | 1 |
| New Lenox, IL | $139.19 | $139.19 – $139.19 | 20 | 1 |
| Millersburg, OH | $303.63 | $303.63 – $303.63 | 20 | 1 |
| Melrose Park, IL | $206.12 | $206.12 – $206.12 | 20 | 1 |
| Fairhope, AL | $156.49 | $156.49 – $156.49 | 20 | 1 |
| Defiance, OH | $395.34 | $395.34 – $395.34 | 19 | 1 |
| Lady Lake, FL | $167.25 | $167.25 – $167.25 | 19 | 1 |
| Fort Walton Beach, FL | $26.90 | $26.90 – $26.90 | 19 | 1 |
| Davidson, NC | $24.82 | $24.82 – $24.82 | 19 | 1 |
| Willoughby, OH | $260.31 | $260.31 – $260.31 | 18 | 1 |
| Longview, TX | $65.40 | $65.40 – $65.40 | 18 | 1 |
| Hannibal, MO | $27.70 | $27.70 – $27.70 | 18 | 1 |
| Lebanon, PA | $97.38 | $97.38 – $97.38 | 18 | 1 |
| Varnville, SC | $0.00 | $0.00 – $0.00 | 18 | 1 |
| Aberdeen, SD | $167.00 | $167.00 – $167.00 | 17 | 1 |
| Delano, CA | $0.00 | $0.00 – $0.00 | 17 | 1 |
| Kingwood, WV | $649.65 | $649.65 – $649.65 | 17 | 1 |
| Ketchikan, AK | $373.86 | $373.86 – $373.86 | 17 | 1 |
| Cortez, CO | $392.35 | $392.35 – $392.35 | 17 | 1 |
| Beaver Falls, PA | $90.45 | $90.45 – $90.45 | 17 | 1 |
| Palos Heights, IL | $207.55 | $207.55 – $207.55 | 17 | 1 |
| Avon, CT | $33.47 | $33.47 – $33.47 | 17 | 1 |
| Mangonia Park, FL | $170.66 | $170.66 – $170.66 | 17 | 1 |
| Aventura, FL | $176.16 | $176.16 – $176.16 | 16 | 1 |
| Floresville, TX | $137.02 | $137.02 – $137.02 | 16 | 1 |
| Bedford, NH | $64.59 | $64.59 – $64.59 | 16 | 1 |
| Athens, GA | $38.65 | $38.65 – $38.65 | 16 | 1 |
| Clarksdale, MS | $0.00 | $0.00 – $0.00 | 16 | 1 |
| Perry, FL | $23.42 | $23.42 – $23.42 | 16 | 1 |
| Euclid, OH | $480.10 | $480.10 – $480.10 | 16 | 1 |
| Thomasville, AL | $127.10 | $127.10 – $127.10 | 16 | 1 |
| Panorama City, CA | $465.50 | $465.50 – $465.50 | 16 | 1 |
| Lehighton, PA | $38.27 | $38.27 – $38.27 | 16 | 1 |
| Goleta, CA | $268.47 | $268.47 – $268.47 | 16 | 1 |
| West Bend, WI | $203.66 | $203.66 – $203.66 | 16 | 1 |
| King, NC | $202.20 | $202.20 – $202.20 | 16 | 1 |
| Port Townsend, WA | $509.48 | $509.48 – $509.48 | 16 | 1 |
| Ephrata, PA | $143.98 | $143.98 – $143.98 | 15 | 1 |
| Vienna, WV | $14.73 | $14.73 – $14.73 | 15 | 1 |
| North Tonawanda, NY | $921.04 | $921.04 – $921.04 | 15 | 1 |
| Sparta, TN | $60.97 | $60.97 – $60.97 | 15 | 1 |
| Galt, CA | $9.78 | $9.78 – $9.78 | 15 | 1 |
| Woodbury, MN | $70.69 | $70.69 – $70.69 | 15 | 1 |
| Hobart, IN | $43.97 | $43.97 – $43.97 | 15 | 1 |
| Berlin, VT | $71.58 | $71.58 – $71.58 | 15 | 1 |
| New Smyrna Beach, FL | $37.06 | $37.06 – $37.06 | 15 | 1 |
| Park Rapids, MN | $874.62 | $874.62 – $874.62 | 15 | 1 |
| Canonsburg, PA | $86.64 | $86.64 – $86.64 | 15 | 1 |
| Thomasville, NC | $95.48 | $95.48 – $95.48 | 15 | 1 |
| Winnsboro, LA | $143.45 | $143.45 – $143.45 | 15 | 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.