Average Charge and Payment Data for 9 Upper-GI Procedures Commonly Performed in ASCs

1. Upper stomach-intestine scope, simple (CPT 43234)
– average sub charge: $817
– average allow charge $303
– average payment: $237

2. Upper stomach-intestine scope for diagnosis (CPT 43235)
– average sub charge: $1,064
– average allow charge $318
– average payment: $249

3. Stomach-intestine scope, inject intestine wall (CPT 43236)
– average sub charge: $1,218
– average allow charge $343
– average payment: $271

4. Upper stomach-intestine scope for biopsy (CPT 43239)
– average sub charge: $1,406
– average allow charge $424
– average payment: $334

5. Stomach-intestine scope ultrasound guided biopsy (CPT 43242)
– average sub charge: $1,959
– average allow charge $443
– average payment: $352

6. Stomach-intestine scope for foreign body removal (CPT 43247)
– average sub charge: $1,405
– average allow charge $421
– average payment: $331

7. Stomach-intestine scope with ultrasound exam (CPT 43259)
– average sub charge: $2,018
– average allow charge $508
– average payment: $402

8. Scope of upper small intestine (CPT 44360)
– average sub charge: $1,468
– average allow charge $433
– average payment: $343

9. Scope of upper small intestine with biopsy (CPT 44361)
– average sub charge: $1,409
– average allow charge $414
– average payment: $327