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 43213 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Esophagoscopy Retro Balloon, Esophagoscopy Flexible Transoral With Dilation Of Esophagus By Balloon Or Dilator Retrograde Includes Fluoroscopic Guidance When Performed
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 52 - Reduced Services GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43213 |
| Medicaid Fee Schedule | View Medicaid rates for 43213 |
National average reimbursement for CPT 43213 by major payers:
$1,389.93
$1,646.15
$1,676.78
$510.44
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43213.
CPT 43213
5 of 25 sample ratesHigher to lower in this preview
West Penn Allegheny Health System Inc., Allegheny General Hospital
Highmark Health
$5,747.16Published rateOrange Park Endoscopy Center LLC
Surgcenter Of Orange Park LLC
$1,528.00Published rateAlexandria Carie-Kroeger
Deaconess Hospital Inc
$953.34Published rateHigh Resort Eye Surgery Center LLC
$582.00Published rateLisa Renfro Surgery Center LLC
$420.00Published 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 43213 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43213 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43213 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43211-CPT | Moderate | Esophagus Exam With Scope, An Exam Of The Esophagus Using A Scope (Endoscope). The Procedure Includes Removing Tissue From The Digestive Tract. |
| 43212-CPT | Moderate | Esophagoscop Stent Placement, Esophagoscopy Flexible Transoral With Placement Of Endoscopic Stent Includes Pre And Post Dilation And Guide Wire Passage When Performed |
| 43213-CPT | High | Esophagoscopy Retro Balloon, Esophagoscopy Flexible Transoral With Dilation Of Esophagus By Balloon Or Dilator Retrograde Includes Fluoroscopic Guidance When Performed |
| 43214-CPT | Moderate | Esophagosc Dilate Balloon 30, Esophagoscopy Flexible Transoral With Dilation Of Esophagus With Balloon 30 Mm Diameter Or Larger Includes Fluoroscopic Guidance When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43213. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43213 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 43213) and we'll show you how you compare in 15 minutes or less.