Reddenda · Rate Intelligence · New York-Newark-Jersey City, NY-NJ

43235 under Empire BlueCross BlueShield (NY) in New York-Newark-Jersey City, NY-NJ

EGD, diagnostic · Local peer median $482.89 · High confidence

• The local peer median for CPT 43235 under Empire BlueCross BlueShield (NY) in New York-Newark-Jersey City, NY-NJ is $482.89, drawn from 548 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• The bottom of the local market (P10) is $167.43 and the top (P90) is $952.75; the median-to-P90 spread is $469.86.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• The lowest published rate in this market is $40.46; the highest is $1,750.58.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• This benchmark is drawn from 549 individual rate records that Empire BlueCross BlueShield (NY) itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• Medicare's national non-facility rate for CPT 43235 is $322.65, making the Empire BlueCross BlueShield (NY) local median 150% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• 14.9% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate
• 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 exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

Modeled from Empire BlueCross BlueShield (NY)'s own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Empire BlueCross BlueShield (NY) to publish this rate. Page generated 2026-08-23 23:55 UTC; the live index is queried in real time on every request.