CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
1. Upper stomach-intestine scope, simple (CPT 43234)
- average sub charge: $1,025
- average allow charge: $329
- average payment: $259
2. Upper stomach-intestine scope for diagnosis (CPT 43235)
- average sub charge: $1,117
- average allow charge $325
- average payment: $255
3. Stomach-intestine scope, inject intestine wall (CPT 43236)
- average sub charge: $1,359
- average allow charge $338
- average payment: $267
4. Upper stomach-intestine scope for biopsy (CPT 43239)
- average sub charge: $1,451
- average allow charge $408
- average payment: $321
5. Stomach-intestine scope ultrasound guided biopsy (CPT 43242)
- average sub charge: $2,116
- average allow charge $404
- average payment: $320
6. Stomach-intestine scope for foreign body removal (CPT 43247)
- average sub charge: $1,458
- average allow charge $408
- average payment: $322
7. Stomach-intestine scope with ultrasound exam (CPT 43259)
- average sub charge: $2,232
- average allow charge $452
- average payment: $359
8. Scope of upper small intestine (CPT 44360)
- average sub charge: $1,419
- average allow charge $416
- average payment: $328
9. Scope of upper small intestine with biopsy (CPT 44361)
- average sub charge: $1,344
- average allow charge $425
- average payment: $336
10. Scope of colon thru ostomy for diagnosis (CPT 44388)
- average sub charge: $1,325
- average allow charge $334
- average payment: $262
11. Scope of colon with biopsy thru ostomy (CPT 44389)
- average sub charge: $1,354
- average allow charge $325
- average payment: $255
12. Scope of sigmoid colon only with biopsy (CPT 45331)
- average sub charge: $967
- average allow charge $267
- average payment: $208
13. Scope of colon for diagnosis (CPT 45378)
- average sub charge: $1,502
- average allow charge $422
- average payment: $330
14. Scope of colon with biopsy (CPT 45380)
- average sub charge: $1,549
- average allow charge $406
- average payment: $318
15. Cancer screen colon scope, high risk patient (HCPCS G0105)
- average sub charge: $1,308
- average allow charge $409
- average payment: $306
16. Cancer screen colon scope, not high risk patient (HCPCS G0121)
- average sub charge: $1,415
- average allow charge $412
- average payment: $308
Source: CMS
