Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43201 Fee Schedule
Medicare rates as of October 2026
CPT 43201 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include An Injection Of A Substance.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $278.23 national non-facility rate (2026) · View Medicare rates for 43201 |
| Medicaid Fee Schedule | $221.91 median of the 8 states in the free preview · View Medicaid rates for 43201 |
National average reimbursement for CPT 43201 by major payers:
$338.49
BCBS / Anthem
$342.15
UnitedHealthcare
$372.19
Aetna
$192.15
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43201.
CPT 43201
5 of 25 sample ratesHigher to lower in this preview
Ssm St Clare Surgical Center LLC, Ssm St Clare Surgical Center
Ssm St Clare Surgical Center LLC
$2,269.00Published rateHouston Urologic Surgicenter, LLC
$1,299.00Published rateGenesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
$1,200.00Published rateRuxton Surgicenter LLC
$577.00Published rateSarah Kung
Deaconess Hospital Inc
$401.61Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43201 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43201. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 43200-CPT | Moderate | Esophagoscopy Flexible Brush, Esophagoscopy Flexible Transoral Diagnostic Including Collection Of Specimen S By Brushing Or Washing When Performed Separate Procedure |
| 43201-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include An Injection Of A Substance. |
| 43202-CPT | Moderate | Esophagus Exam With Scope, Exam Of The Esophagus Using A Scope (Endoscope). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 43204-CPT | Moderate | Esophagoscopy Flex Transoral; W/ Inject Sclerosis Of Esopha, Esophagoscopy Flexible Transoral; With Injection Sclerosis Of Esopha |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43201. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43201 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43201) and we'll show you how you compare in 15 minutes or less.