Reddenda · Rate Intelligence · Augusta-Richmond County, GA-SC
43250 under Bcbs Sc in Augusta-Richmond County, GA-SC
EGD w/ tumor removal, hot biopsy · Local peer median $408 · Medium confidence
Local distribution · 82 providers · 82 rate records
- The local peer median for CPT 43250 under Bcbs Sc in Augusta-Richmond County, GA-SC is $408, drawn from 82 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Sc to publish this rate
- The bottom of the local market (P10) is $408 and the top (P90) is $428.40; the median-to-P90 spread is $20.40.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Sc to publish this rate
- The lowest published rate in this market is $367.20; the highest is $541.96.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Sc to publish this rate
- This benchmark is drawn from 82 individual rate records that Bcbs Sc itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Sc to publish this rate
- Medicare's national non-facility rate for CPT 43250 is $498.68, making the Bcbs Sc local median 82% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbs Sc to publish this rate
- 72% 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 Bcbs Sc 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)
82 providers bill this code to this payer in this metro.
Find yourself on this curve. Enter your NPI: no account, no email, no PHI.
See where your rate lands
This is the local market for CPT 43250 (EGD w/ tumor removal, hot biopsy) under Bcbs Sc in Augusta-Richmond County, GA-SC. 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.
Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.
Modeled from Bcbs Sc'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 Bcbs Sc to publish this rate. Page generated 2026-08-24 21:45 UTC; the live index is queried in real time on every request.