What is the top of the local market (P90) for CPT 43245 under Bcbsil for Denver-Aurora-Centennial, CO providers?

The P90, the top of the local market and Reddenda's target rate, is $1,308.92.

How does Bcbsil's rate for CPT 43245 compare to Medicare?

The Bcbsil local median of $778.63 is 119% of Medicare's national non-facility rate of $654.99 for CPT 43245.

Reddenda · Rate Intelligence · Denver-Aurora-Centennial, CO

43245 under Bcbsil, for Denver-Aurora-Centennial, CO providers

Name: Bcbsil rates for CPT 43245 among Denver-Aurora-Centennial, CO providers
Creator: Reddenda

EGD w/ dilation gastric outlet · Local peer median $778.63 · High confidence

$778.63 local peer median. Bcbsil's published rate file lists a local peer median of $778.63 for CPT 43245 (EGD w/ dilation gastric outlet) among 822 indexed providers in Denver-Aurora-Centennial, CO. 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 $1,308.92, 68% above the median. A provider billed below this median is being paid less than peers holding the identical Bcbsil contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 822 providers · 825 rate records

P10

$236.52

P25

$289.10

Median

$778.63

P75

$1,076.36

P90 (target)

$1,308.92

P10$236.52

P25$289.10

Median (P50)$778.63

P75$1,076.36

P90 target$1,308.92

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $136.19 – $2,451.25

The local peer median for CPT 43245 under Bcbsil for Denver-Aurora-Centennial, CO providers is $778.63, drawn from 822 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
The bottom of the local market (P10) is $236.52 and the top (P90) is $1,308.92; the median-to-P90 spread is $530.29.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
The lowest published rate in this market is $136.19; the highest is $2,451.25.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
This benchmark is drawn from 825 individual rate records that Bcbsil itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
Medicare's national non-facility rate for CPT 43245 is $654.99, making the Bcbsil local median 119% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
10.4% 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 Bcbsil 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)

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

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These are the rates Bcbsil publishes for CPT 43245 (EGD w/ dilation gastric outlet) among Denver-Aurora-Centennial, CO providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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

Modeled from Bcbsil'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 Bcbsil to publish this rate. Page generated 2026-08-23 23:16 UTC; the live index is queried in real time on every request.