43249
Upper GI endoscopy with balloon dilation of esophagus
Upper GI endoscopy with balloon dilation of esophagus is the #2,035 most-billed Medicaid procedure code, with $9.8M in payments across 28K claims from 2018–2024. The national median cost per claim is $153.37. Costs vary widely — the 90th percentile is $574.06 per claim, 3.7× the median.
Total Paid
$9.8M
0.00% of all spending
Total Claims
28K
Providers
171
Avg Cost/Claim
$350
National Cost Distribution
How much do providers bill per claim for 43249? Based on 163 providers billing this code nationally.
Median
$153.37
Average
$255.85
Std Dev
$287.21
Max
$1,989.14
Percentile Distribution (Cost per Claim)
50% of providers bill between $77.19 and $324.05 per claim for this code.
90% bill between $43.24 and $574.06.
Top 1% bill above $1,228.13.
About This Procedure
HCPCS code 43249 (Upper GI endoscopy with balloon dilation of esophagus) was billed by 171 providers across 28K claims, totaling $9.8M in Medicaid payments from 2018–2024. This code was used for 25K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$153.37
Providers Billing
163
National Spending
$9.8M
Avg/Median Ratio
1.67×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 43249
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1063457380 | $2.7M |
| 2 | Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital | $1.1M |
| 3 | 1700831724 | $959K |
| 4 | 1598710147 | $544K |
| 5 | Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital | $382K |
| 6 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $348K |
| 7 | 1588731087 | $206K |
| 8 | 1265689111 | $189K |
| 9 | 1588668842 | $188K |
| 10 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $187K |
| 11 | 1558390781 | $154K |
| 12 | 1932586260 | $152K |
| 13 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $151K |
| 14 | 1477527398 | $149K |
| 15 | 1700112745 | $146K |
| 16 | Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine | $119K |
| 17 | 1487759858 | $109K |
| 18 | 1487607784 | $88K |
| 19 | Eastern Maine Medical Center Bangor, ME · General Acute Care Hospital | $85K |
| 20 | 1265489157 | $81K |
Showing top 20 of 171 providers billing this code