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 43226 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible With Insertion Of Guidewire Followed By Dilation Over Guide Wire Esophagoscopy Rigid Or Flexible With Insertion Of Guide
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 43226 |
| Medicaid Fee Schedule | View Medicaid rates for 43226 |
National average reimbursement for CPT 43226 by major payers:
$364.08
$383.79
$472.01
$239.09
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43226.
CPT 43226
5 of 25 sample ratesHigher to lower in this preview
South Bend Specialty Surgery Center, LLC
South Bend Specialty Surgery Center LLC
$2,889.00Published ratePhysician'S Surgery Center Of Knoxville LLC
Physicians Surgery Center Of Knoxville LLC
$1,276.00Published rateAdvanced Surgery Center Of San Antonio, LLC
$1,000.00Published rateMidatlantic Endoscopy LLC, Mid-Atlantic Gastrointestinal Center II
$600.00Published rateAdvanced Eye Surgery Center, LLC
Advanced Eye Surgery Center LLC
$437.00Published 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 43226 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43226 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 43226 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 |
|---|---|---|
| 43220-CPT | Moderate | Esophagus Enlargement, Exam Of The Esophagus Aided By A Scope (Endoscope). The Procedure Inserts A Balloon That Is Inflated In Order To Enlarge Or Open Up The Esophagus. |
| 43226-CPT | Moderate | Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible With Insertion Of Guidewire Followed By Dilation Over Guide Wire Esophagoscopy Rigid Or Flexible With Insertion Of Guide |
| 43229-CPT | Moderate | Esophagoscopy Lesion Ablate, Esophagoscopy Flexible Transoral With Ablation Of Tumor S Polyp S Or Other Lesion S Includes Pre And Post Dilation And Guide Wire Passage When Performed |
| 43231-CPT | Moderate | Esophagoscopy Rigid Or Flexib, Esophagoscopy Rigid Or Flexible Diagnostic With Or Without Collection Of Specimens By Brushing Or Washing (Separate Procedure) With Endoscopic Ultrasound Examination. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43226 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 43226) and we'll show you how you compare in 15 minutes or less.