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 |
|---|---|---|---|---|
| Fairfield, CT | $49.40 | $0.00 – $79.40 | 3,698 | 8 |
| Salem, KY | $179.65 | $85.53 – $346.28 | 3,693 | 4 |
| Chillicothe, OH | $172.75 | $66.64 – $491.33 | 3,681 | 10 |
| Belleville, NJ | $828.44 | $81.42 – $1,118 | 3,667 | 4 |
| Chico, CA | $143.56 | $51.38 – $432.14 | 3,666 | 6 |
| South Bend, IN | $117.90 | $44.37 – $157.11 | 3,658 | 8 |
| Oxnard, CA | $238.11 | $73.27 – $486.82 | 3,655 | 7 |
| Vidalia, LA | $104.89 | $101.89 – $109.96 | 3,624 | 2 |
| West Orange, NJ | $463.68 | $29.35 – $497.02 | 3,618 | 6 |
| Urbana, IL | $171.99 | $157.55 – $251.83 | 3,617 | 7 |
| Mayaguez, PR | $328.04 | $80.28 – $360.21 | 3,607 | 9 |
| Winchester, KY | $198.53 | $89.94 – $220.56 | 3,600 | 2 |
| Reno, NV | $141.40 | $0.94 – $175.52 | 3,589 | 11 |
| West Covina, CA | $89.75 | $43.83 – $118.72 | 3,588 | 3 |
| Corvallis, OR | $343.67 | $101.26 – $401.93 | 3,573 | 7 |
| Beloit, WI | $152.40 | $105.45 – $162.46 | 3,537 | 5 |
| Missoula, MT | $75.18 | $35.29 – $256.36 | 3,533 | 9 |
| Prospect Park, NJ | $200.18 | $200.18 – $200.18 | 3,518 | 1 |
| Salem, VA | $248.70 | $35.48 – $340.38 | 3,517 | 3 |
| San Antonio, TX | $135.53 | $23.90 – $515.53 | 3,510 | 23 |
| Upland, CA | $212.14 | $23.90 – $322.17 | 3,499 | 7 |
| Arecibo, PR | $133.46 | $83.16 – $320.00 | 3,496 | 10 |
| Fountain Valley, CA | $153.84 | $0.00 – $402.07 | 3,494 | 13 |
| Georgetown, KY | $268.89 | $131.80 – $269.40 | 3,484 | 2 |
| Kenosha, WI | $183.56 | $74.65 – $208.06 | 3,459 | 7 |
| Lebanon, NH | $168.05 | $47.17 – $217.62 | 3,455 | 8 |
| Saint Joseph, MI | $199.91 | $57.75 – $328.45 | 3,449 | 4 |
| Lorain, OH | $226.38 | $116.17 – $379.38 | 3,437 | 5 |
| New Britain, CT | $196.98 | $33.53 – $381.10 | 3,435 | 6 |
| Oak Ridge, TN | $180.66 | $92.41 – $275.36 | 3,435 | 6 |
| Anderson, SC | $18.42 | $16.12 – $60.40 | 3,422 | 3 |
| Secaucus, NJ | $505.93 | $62.97 – $782.32 | 3,419 | 5 |
| Cape May Court House, NJ | $371.80 | $127.15 – $468.76 | 3,416 | 5 |
| Winchester, VA | $453.91 | $46.91 – $482.65 | 3,404 | 5 |
| Germantown, TN | $30.88 | $6.63 – $90.97 | 3,404 | 5 |
| Encino, CA | $27.77 | $0.92 – $191.20 | 3,403 | 4 |
| Neptune, NJ | $457.62 | $85.45 – $1,078 | 3,400 | 9 |
| Burnt Hills, NY | $421.52 | $58.25 – $528.25 | 3,393 | 7 |
| Beavercreek, OH | $210.53 | $94.06 – $301.71 | 3,390 | 8 |
| Bend, OR | $159.28 | $0.00 – $252.88 | 3,369 | 10 |
| Teaneck, NJ | $771.05 | $61.15 – $775.09 | 3,364 | 2 |
| Whitesburg, KY | $216.69 | $82.11 – $321.85 | 3,349 | 4 |
| Allentown, PA | $224.11 | $86.50 – $325.16 | 3,343 | 15 |
| Everett, WA | $179.58 | $19.98 – $275.78 | 3,340 | 6 |
| Pleasant Prairie, WI | $168.13 | $151.35 – $168.46 | 3,336 | 2 |
| Madison Heights, MI | $357.79 | $302.28 – $359.37 | 3,335 | 2 |
| Mechanicsville, VA | $367.81 | $58.16 – $381.64 | 3,317 | 4 |
| Lanham, MD | $193.62 | $161.64 – $198.13 | 3,312 | 2 |
| Cookeville, TN | $185.65 | $99.02 – $226.10 | 3,308 | 5 |
| Leominster, MA | $140.69 | $52.42 – $193.36 | 3,300 | 5 |
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.