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 |
|---|---|---|---|---|
| Mount Laurel, NJ | $377.84 | $310.45 – $489.32 | 7,096 | 15 |
| Escondido, CA | $285.26 | $83.78 – $361.48 | 7,076 | 4 |
| Louisa, KY | $207.90 | $81.55 – $328.00 | 7,053 | 2 |
| Newport News, VA | $449.35 | $47.02 – $612.66 | 7,028 | 11 |
| Farmington, CT | $291.73 | $6.99 – $426.95 | 7,003 | 16 |
| Loma Linda, CA | $117.84 | $46.97 – $452.28 | 6,948 | 17 |
| Fort Worth, TX | $154.00 | $37.87 – $251.79 | 6,934 | 19 |
| Tupelo, MS | $132.17 | $36.15 – $138.73 | 6,892 | 11 |
| Redlands, CA | $361.23 | $198.56 – $403.01 | 6,885 | 5 |
| Fredericksburg, VA | $373.90 | $49.92 – $579.42 | 6,860 | 10 |
| Tulsa, OK | $176.58 | $57.16 – $616.61 | 6,821 | 35 |
| Fort Smith, AR | $85.78 | $82.02 – $130.32 | 6,808 | 5 |
| Murrieta, CA | $286.02 | $30.57 – $354.59 | 6,793 | 7 |
| Evansville, IN | $381.03 | $95.33 – $520.47 | 6,775 | 9 |
| Minneapolis, MN | $328.55 | $43.16 – $437.83 | 6,767 | 14 |
| Bastrop, LA | $196.33 | $196.33 – $196.33 | 6,744 | 1 |
| Mineola, NY | $416.08 | $70.30 – $670.53 | 6,700 | 6 |
| Kalispell, MT | $114.75 | $2.62 – $145.86 | 6,696 | 9 |
| Elmhurst, NY | $251.98 | $82.89 – $582.85 | 6,685 | 8 |
| Richmond, KY | $283.15 | $87.56 – $414.69 | 6,668 | 4 |
| Long Beach, CA | $98.54 | $27.82 – $369.76 | 6,662 | 10 |
| Spokane Valley, WA | $188.75 | $42.95 – $284.50 | 6,635 | 5 |
| East Lansing, MI | $59.55 | $57.59 – $84.91 | 6,634 | 3 |
| Birmingham, AL | $302.61 | $0.00 – $517.61 | 6,605 | 17 |
| Alhambra, CA | $173.51 | $27.64 – $321.73 | 6,599 | 8 |
| Maitland, FL | $174.08 | $47.00 – $280.52 | 6,588 | 6 |
| Ogden, UT | $88.15 | $6.57 – $174.51 | 6,559 | 12 |
| Chandler, AZ | $138.98 | $19.66 – $206.29 | 6,552 | 18 |
| Bayamon, PR | $307.47 | $55.39 – $398.29 | 6,539 | 14 |
| Marrero, LA | $173.69 | $31.63 – $263.49 | 6,508 | 10 |
| Morristown, TN | $137.14 | $124.35 – $145.08 | 6,443 | 2 |
| Newport, TN | $131.81 | $131.81 – $131.81 | 6,437 | 1 |
| Boise, ID | $200.57 | $75.29 – $223.23 | 6,385 | 16 |
| Fort Myers, FL | $127.39 | $13.21 – $220.92 | 6,383 | 15 |
| Haverhill, MA | $141.52 | $21.83 – $176.12 | 6,372 | 4 |
| Columbia, TN | $66.57 | $59.37 – $83.20 | 6,364 | 4 |
| Augusta, ME | $283.67 | $70.45 – $298.65 | 6,335 | 2 |
| El Cajon, CA | $369.90 | $158.00 – $393.01 | 6,315 | 2 |
| Moreno Valley, CA | $80.48 | $29.45 – $161.31 | 6,304 | 3 |
| Columbia, MO | $229.39 | $50.08 – $541.79 | 6,272 | 24 |
| Greeneville, TN | $135.99 | $112.23 – $137.52 | 6,267 | 2 |
| Hilliard, OH | $198.30 | $162.85 – $334.62 | 6,235 | 5 |
| Coto Laurel, PR | $279.22 | $110.31 – $320.55 | 6,232 | 3 |
| Morgantown, WV | $152.05 | $55.01 – $274.74 | 6,230 | 12 |
| Lake Charles, LA | $133.55 | $18.16 – $238.24 | 6,218 | 5 |
| Jacksonville, NC | $105.52 | $61.10 – $169.23 | 6,210 | 4 |
| Framingham, MA | $281.82 | $53.27 – $706.66 | 6,197 | 4 |
| Princeton, WV | $165.91 | $41.76 – $180.84 | 6,190 | 6 |
| Grand Junction, CO | $168.92 | $91.23 – $259.88 | 6,086 | 9 |
| Mccomb, MS | $186.85 | $59.98 – $269.45 | 6,081 | 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.