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 |
|---|---|---|---|---|
| Oceanside, CA | $167.54 | $160.44 – $197.75 | 5,005 | 9 |
| Hanford, CA | $28.26 | $5.15 – $45.03 | 4,999 | 5 |
| Montgomery, OH | $192.39 | $85.86 – $377.02 | 4,989 | 9 |
| Yonkers, NY | $397.60 | $97.72 – $890.78 | 4,978 | 7 |
| South Boston, VA | $280.05 | $59.73 – $437.36 | 4,966 | 3 |
| Ypsilanti, MI | $138.38 | $60.43 – $378.84 | 4,877 | 4 |
| Hopkinsville, KY | $259.06 | $79.55 – $328.05 | 4,877 | 3 |
| Columbus, IN | $85.17 | $72.81 – $92.11 | 4,843 | 2 |
| Moline, IL | $185.88 | $169.01 – $224.61 | 4,837 | 3 |
| Uniontown, PA | $105.37 | $82.35 – $118.10 | 4,810 | 4 |
| Edinburg, TX | $180.65 | $45.35 – $358.47 | 4,804 | 6 |
| Wilmington, NC | $149.91 | $32.98 – $183.47 | 4,776 | 9 |
| Prescott, AZ | $199.63 | $69.19 – $340.62 | 4,763 | 4 |
| Murray, KY | $162.55 | $77.01 – $227.77 | 4,735 | 3 |
| Cambridge, MA | $441.71 | $55.33 – $808.38 | 4,705 | 5 |
| Union City, TN | $103.17 | $96.84 – $118.43 | 4,692 | 2 |
| Metuchen, NJ | $167.94 | $154.82 – $182.76 | 4,687 | 2 |
| London, KY | $176.49 | $63.67 – $354.21 | 4,678 | 4 |
| Stockton, CA | $504.35 | $4.87 – $556.85 | 4,669 | 4 |
| Norfolk, NE | $84.79 | $83.67 – $288.72 | 4,614 | 2 |
| Franklin Lakes, NJ | $113.13 | $113.13 – $113.13 | 4,571 | 1 |
| Logan, WV | $127.05 | $67.37 – $198.44 | 4,561 | 3 |
| Lowell, MA | $579.72 | $51.08 – $839.59 | 4,551 | 6 |
| Dallas, TX | $264.67 | $0.00 – $1,416 | 4,549 | 21 |
| Great Neck, NY | $271.99 | $0.00 – $292.36 | 4,518 | 5 |
| Omaha, NE | $370.28 | $42.04 – $1,376 | 4,508 | 28 |
| Lakewood, NJ | $488.11 | $145.52 – $1,482 | 4,507 | 4 |
| Auburn, MA | $183.42 | $125.80 – $222.73 | 4,472 | 3 |
| New London, CT | $163.20 | $54.69 – $385.11 | 4,470 | 6 |
| Huntsville, AL | $204.84 | $46.44 – $270.83 | 4,468 | 9 |
| Albany, GA | $173.51 | $173.51 – $173.51 | 4,459 | 1 |
| Binghamton, NY | $631.20 | $76.56 – $735.08 | 4,450 | 9 |
| East Patchogue, NY | $353.60 | $89.48 – $444.20 | 4,447 | 3 |
| Oregon, OH | $135.44 | $62.49 – $186.04 | 4,445 | 6 |
| Cleveland, TN | $97.22 | $93.84 – $134.22 | 4,432 | 3 |
| West Islip, NY | $576.81 | $113.82 – $686.56 | 4,431 | 4 |
| Hawthorne, NJ | $375.36 | $375.36 – $375.36 | 4,406 | 1 |
| Richland, WA | $183.80 | $65.54 – $269.62 | 4,394 | 6 |
| Manchester, NH | $192.76 | $50.82 – $273.96 | 4,393 | 10 |
| La Crosse, WI | $173.76 | $59.39 – $290.78 | 4,391 | 8 |
| Lakewood, CO | $129.67 | $89.67 – $147.82 | 4,391 | 9 |
| Alexandria, VA | $295.36 | $45.34 – $519.40 | 4,360 | 9 |
| Marshfield, WI | $192.88 | $71.18 – $348.43 | 4,341 | 7 |
| Sioux Falls, SD | $146.29 | $109.55 – $176.83 | 4,325 | 7 |
| Great Falls, MT | $28.58 | $2.13 – $82.49 | 4,304 | 3 |
| Pensacola, FL | $86.75 | $17.91 – $274.44 | 4,301 | 11 |
| Walnut Creek, CA | $265.72 | $54.58 – $576.62 | 4,299 | 14 |
| Cherry Hill, NJ | $186.41 | $102.83 – $372.88 | 4,297 | 10 |
| Ocean Springs, MS | $140.23 | $40.78 – $270.20 | 4,296 | 7 |
| Manteca, CA | $249.74 | $236.57 – $357.38 | 4,266 | 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.