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 |
|---|---|---|---|---|
| Covington, GA | $36.93 | $36.93 – $36.93 | 13 | 1 |
| Woodstock, IL | $226.66 | $226.66 – $226.66 | 13 | 1 |
| Franklin, VA | $599.85 | $599.85 – $599.85 | 13 | 1 |
| Lake Barrington, IL | $135.04 | $135.04 – $135.04 | 13 | 1 |
| Falmouth, MA | $70.26 | $70.26 – $70.26 | 13 | 1 |
| Socorro, NM | $662.62 | $662.62 – $662.62 | 13 | 1 |
| Jamaica Plain, MA | $56.27 | $56.27 – $56.27 | 13 | 1 |
| South Euclid, OH | $280.99 | $280.99 – $280.99 | 13 | 1 |
| Hiram, GA | $195.28 | $195.28 – $195.28 | 13 | 1 |
| Fairview Park, OH | $239.41 | $239.41 – $239.41 | 13 | 1 |
| Litchfield, IL | $190.85 | $190.85 – $190.85 | 13 | 1 |
| Northville, MI | $147.31 | $147.31 – $147.31 | 13 | 1 |
| Lancaster, TX | $402.18 | $402.18 – $402.18 | 13 | 1 |
| Delmar, MD | $280.96 | $280.96 – $280.96 | 13 | 1 |
| Arrecibo, PR | $79.25 | $79.25 – $79.25 | 13 | 1 |
| York, PA | $88.31 | $88.31 – $88.31 | 12 | 1 |
| Ames, IA | $101.71 | $101.71 – $101.71 | 12 | 1 |
| Mount Shasta, CA | $115.05 | $115.05 – $115.05 | 12 | 1 |
| Doylestown, PA | $98.57 | $98.57 – $98.57 | 12 | 1 |
| Columbus, GA | $100.49 | $100.49 – $100.49 | 12 | 1 |
| Kingwood, TX | $140.64 | $140.64 – $140.64 | 12 | 1 |
| Midland, TX | $541.87 | $541.87 – $541.87 | 12 | 1 |
| Sherman, TX | $53.96 | $53.96 – $53.96 | 12 | 1 |
| Cheyenne, WY | $61.27 | $61.27 – $61.27 | 12 | 1 |
| Lawrenceville, NJ | $186.67 | $186.67 – $186.67 | 12 | 1 |
| Yorktown Hts, NY | $164.45 | $164.45 – $164.45 | 12 | 1 |
| Lexington, VA | $832.41 | $832.41 – $832.41 | 12 | 1 |
| Pomona, NY | $316.44 | $316.44 – $316.44 | 12 | 1 |
| Winona, MN | $619.88 | $619.88 – $619.88 | 12 | 1 |
| San Dimas, CA | $0.00 | $0.00 – $0.00 | 12 | 1 |
| Chesterfield, MI | $54.52 | $54.52 – $54.52 | 12 | 1 |
| Princeton, NJ | $57.90 | $57.90 – $57.90 | 12 | 1 |
| Maplewood, MN | $51.50 | $51.50 – $51.50 | 12 | 1 |
| St Clair Shores, MI | $243.42 | $243.42 – $243.42 | 12 | 1 |
| Clinton, SC | $0.00 | $0.00 – $0.00 | 12 | 1 |
| Arcata, CA | $37.74 | $37.74 – $37.74 | 12 | 1 |
| Coldwater, MI | $441.57 | $441.57 – $441.57 | 12 | 1 |
| Standish, MI | $270.65 | $270.65 – $270.65 | 12 | 1 |
| Ardmore, OK | $341.19 | $341.19 – $341.19 | 12 | 1 |
| Eynon, PA | $115.65 | $115.65 – $115.65 | 12 | 1 |
| Haddon Heights, NJ | $125.98 | $125.98 – $125.98 | 12 | 1 |
| Robbinsdale, MN | $59.45 | $59.45 – $59.45 | 12 | 1 |
| Livermore, CA | $196.46 | $196.46 – $196.46 | 12 | 1 |
| Glenview, IL | $88.34 | $88.34 – $88.34 | 12 | 1 |
| Scarsdale, NY | $129.35 | $129.35 – $129.35 | 12 | 1 |
| Highland Park, IL | $222.96 | $222.96 – $222.96 | 12 | 1 |
| Delmont, PA | $88.51 | $88.51 – $88.51 | 12 | 1 |
| Fort Sam Houston, TX | $174.41 | $174.41 – $174.41 | 12 | 1 |
| Queen Creek, AZ | $496.25 | $496.25 – $496.25 | 12 | 1 |
| Sikeston, MO | $61.67 | $61.67 – $61.67 | 12 | 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.