CPT 43213 Surgery - Digestive
Esophagoscopy retro balloon Cost
Body System: Digestive
Medicare Facility Rate
$225
CMS PFS CY2026
Medicare Non-Facility Rate
$1,254
Office/clinic setting
Hospital Outpatient
$1
OPPS rate
Surgery Center (ASC)
$894
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
4.51
Work RVU
1.57
Facility PE RVU
0.67
Malpractice RVU
37.55
Total RVU
Frequently Asked Questions
How much does Esophagoscopy retro balloon cost?
The Medicare facility rate is $225. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $1. Ambulatory surgery center rate: $894.
How much does Esophagoscopy retro balloon cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $225.