What do doctors typically charge for Balloon Dilation of Esophagus using a Rigid Endoscope?

The nationwide median physician charge for Balloon Dilation of Esophagus using a Rigid Endoscope (CPT 43195) is $961.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 43195?

The standard insurance baseline reimbursement rate is $171.28. This represents the customary allowable amount established across standard fee schedules.

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CPT 43195Medical Service

Balloon Dilation of Esophagus using a Rigid Endoscope

Balloon dilation of esophagus using a rigid endoscope, less than 3.0 cm. Clinical pricing breakdown and utilization metrics across 3 practicing doctors nationwide.

$961.00

Peer Median Charge

Gross billed rate

$171.28

Standard Baseline

Customary allowable

5.6x

National Markup

Charge vs baseline

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $961.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $171.28 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 43195 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"