Reddenda · Rate Intelligence · National

43245: EGD w/ dilation gastric outlet

What commercial payers pay · observed distribution across payer filings · 2,910,545 rate observations

• The national median commercial rate observed for CPT 43245 (EGD w/ dilation gastric outlet) is $392.66, from 2,910,545 published rate records across payers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels payers to publish these rates
• The observed spread runs from a 25th percentile of $237.18 to a 90th percentile of $1,313.90: a 454% difference between the low and high of the distribution for the same code.Source: 45 CFR §147.212 (Transparency in Coverage)
• Medicare's national non-facility rate for CPT 43245 is $654.99, so the observed commercial median of $392.66 is about 60% of Medicare.Source: CMS Medicare Physician Fee Schedule
• This is a national distribution across payers, not a local or payer-specific benchmark. What a specific provider is actually paid depends on its own contracts and local market; a RateScore measures that against local peers.Source: Reddenda methodology
• A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this code.Source: 45 CFR §149.510(c)(4)(iii)(B) (No Surprises Act IDR)

Observed distribution across payer filings nationally, modeled from public rates and never guaranteed. This is not a local peer median or a RateScore: those measure a specific provider against its local peers and its own payers. Basis: CMS-descriptor CPT 43245 across indexed commercial payer files. Federal citation for the underlying obligation: 45 CFR §147.212. As of 2026-07-24; page generated 2026-07-24 17:53 UTC.