43235
Upper GI endoscopy, diagnostic, including collection
Upper GI endoscopy, diagnostic, including collection is the #981 most-billed Medicaid procedure code, with $51.6M in payments across 203K claims from 2018–2024. The national median cost per claim is $114.30. Costs vary widely — the 90th percentile is $485.99 per claim, 4.3× the median.
Total Paid
$51.6M
0.00% of all spending
Total Claims
203K
Providers
875
Avg Cost/Claim
$255
National Cost Distribution
How much do providers bill per claim for 43235? Based on 858 providers billing this code nationally.
Median
$114.30
Average
$207.30
Std Dev
$227.97
Max
$2,273.62
Percentile Distribution (Cost per Claim)
50% of providers bill between $62.33 and $296.78 per claim for this code.
90% bill between $41.91 and $485.99.
Top 1% bill above $1,001.72.
About This Procedure
HCPCS code 43235 (Upper GI endoscopy, diagnostic, including collection) was billed by 875 providers across 203K claims, totaling $51.6M in Medicaid payments from 2018–2024. This code was used for 186K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$114.30
Providers Billing
858
National Spending
$51.6M
Avg/Median Ratio
1.81×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 43235
| # | Provider | Total Paid |
|---|---|---|
| 1 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $3.0M |
| 2 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $2.1M |
| 3 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $2.0M |
| 4 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $1.9M |
| 5 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $1.1M |
| 6 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $1.0M |
| 7 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $1.0M |
| 8 | Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital | $982K |
| 9 | Banner - University Medical Center Phoenix Phoenix, AZ · Clinic/Center, Sleep Disorder Diagnostic | $905K |
| 10 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $832K |
| 11 | Beth Israel Deaconess Medical Center, Inc. Boston, MA · General Acute Care Hospital | $796K |
| 12 | Pine Ridge Indian Health Service Hospital Pine Ridge, SD · General Acute Care Hospital | $777K |
| 13 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $762K |
| 14 | Unm Hospital Albuquerque, NM · General Acute Care Hospital | $694K |
| 15 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $676K |
| 16 | 1558392563 | $632K |
| 17 | 1215139233 | $601K |
| 18 | 1619163854 | $593K |
| 19 | Carilion Medical Center Roanoke, VA · General Acute Care Hospital | $577K |
| 20 | Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | $540K |
Showing top 20 of 875 providers billing this code