What is the top of the local market (P90) for CPT 43235 under Horizon Nj for Baltimore-Columbia-Towson, MD providers?

The P90, the top of the local market and Reddenda's target rate, is $388.52.

How does Horizon Nj's rate for CPT 43235 compare to Medicare?

The Horizon Nj local median of $131.07 is 41% of Medicare's national non-facility rate of $322.65 for CPT 43235.

Reddenda · Rate Intelligence · Baltimore-Columbia-Towson, MD

43235 under Horizon Nj, for Baltimore-Columbia-Towson, MD providers

Name: Horizon Nj rates for CPT 43235 among Baltimore-Columbia-Towson, MD providers
Creator: Reddenda

EGD, diagnostic · Local peer median $131.07 · Medium confidence

$131.07 local peer median. Horizon Nj's published rate file lists a local peer median of $131.07 for CPT 43235 (EGD, diagnostic) among 1252 indexed providers in Baltimore-Columbia-Towson, MD. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $388.52, 196% above the median. A provider billed below this median is being paid less than peers holding the identical Horizon Nj contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 1252 providers · 1294 rate records

P10

$131.07

P25

$131.07

Median

$131.07

P75

$216.27

P90 (target)

$388.52

P10$131.07

P25$131.07

Median (P50)$131.07

P75$216.27

P90 target$388.52

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $131.07 – $823.80

The local peer median for CPT 43235 under Horizon Nj for Baltimore-Columbia-Towson, MD providers is $131.07, drawn from 1252 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
The bottom of the local market (P10) is $131.07 and the top (P90) is $388.52; the median-to-P90 spread is $257.45.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
The lowest published rate in this market is $131.07; the highest is $823.80.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
This benchmark is drawn from 1294 individual rate records that Horizon Nj itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
Medicare's national non-facility rate for CPT 43235 is $322.65, making the Horizon Nj local median 41% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
60.6% 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 Horizon Nj 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)

1252 providers bill this code to this payer in this metro.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Horizon Nj'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 Horizon Nj to publish this rate. Page generated 2026-08-23 23:50 UTC; the live index is queried in real time on every request.