Gastroenterology · Pennsylvania
Gastroenterology commercial reimbursement in Pennsylvania
How Pennsylvania gastroenterology rates compare with the national market.
Gastroenterology in Pennsylvania
36 codes · 115 sampled providers
Index vs national
98
2% below
Rank among states
26 of 50
1 = highest
Codes above national
16 of 36
median code at 98%
Providers
115
sampled
What the data shows
1
Gastroenterology ranks 26th of 50 states in Pennsylvania with an index of 98 (100 = the specialty's national median), across 36 codes and 115 sampled providers.
2
Of the 36 gastroenterology codes with enough data in Pennsylvania, 16 pay above the national median and 20 below; the typical code sits at 98% of the national median.
3
Largest premium over the national median: CPT 99212 (Office o/p est sf 10 min) at 118%; largest discount: CPT 43237 (Endoscopic us exam esoph) at 88%.
4
Measured against Medicare, Pennsylvania gastroenterology rates have a median of 168% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All gastroenterology codes in Pennsylvania
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 99212 Office o/p est sf 10 min | $60 | $51 | +18% | 102% | 114 | 203 | |
| CPT 99204 Office o/p new mod 45 min | $212 | $194 | +9% | 120% | 114 | 173 | |
| CPT 99215 Office o/p est hi 40 min | $200 | $185 | +8% | 104% | 114 | 173 | |
| CPT 99214 Office o/p est mod 30 min | $142 | $132 | +7% | 104% | 114 | 175 | |
| CPT 88312 Special stains group 1 | $105 | $99 | +6% | 95% | 114 | 207 | |
| CPT 88313 Special stains group 2 | $74 | $71 | +5% | 92% | 114 | 205 | |
| CPT 99205 Office o/p new hi 60 min | $265 | $252 | +5% | 112% | 115 | 199 | |
| CPT 43239 Egd biopsy single/multiple | $365 | $349 | +5% | 295% | 114 | 191 | |
| CPT 43251 Egd remove lesion snare | $440 | $425 | +4% | 254% | 113 | 172 | |
| CPT 45378 Diagnostic colonoscopy | $421 | $408 | +3% | 256% | 115 | 206 | |
| CPT 99203 Office o/p new low 30 min | $127 | $124 | +3% | 108% | 115 | 206 | |
| CPT 43248 Egd guide wire insertion | $372 | $364 | +2% | 252% | 113 | 169 | |
| CPT 99213 Office o/p est low 20 min | $92 | $90 | +2% | 97% | 114 | 177 | |
| CPT 45385 Colonoscopy w/lesion removal | $564 | $556 | +1% | 252% | 114 | 170 | |
| CPT 45380 Colonoscopy and biopsy | $476 | $470 | +1% | 268% | 114 | 173 | |
| CPT 99490 Chrnc care mgmt staff 1st 20 | $60 | $60 | +1% | 91% | 114 | 208 | |
| CPT 43255 Egd control bleeding any | $456 | $459 | -1% | 258% | 113 | 167 | |
| CPT 43249 Esoph egd dilation <30 mm | $265 | $271 | -2% | 195% | 114 | 166 | |
| CPT 91110 Gi trc img intral esoph-ile | $1,145 | $1,175 | -3% | 143% | 115 | 213 | |
| CPT 93000 Electrocardiogram complete | $25 | $25 | -3% | 160% | 115 | 210 | |
| CPT 43264 Ercp remove duct calculi | $602 | $622 | -3% | 190% | 114 | 173 | |
| CPT 45388 Colonoscopy w/ablation | $473 | $492 | -4% | 198% | 114 | 205 | |
| CPT 88305 Tissue exam by pathologist | $69 | $71 | -4% | 98% | 114 | 207 | |
| CPT 43235 Egd diagnostic brush wash | $279 | $294 | -5% | 253% | 114 | 173 | |
| CPT 43242 Egd us fine needle bx/aspir | $424 | $454 | -7% | 184% | 113 | 170 | |
| CPT 46221 Ligation of hemorrhoid(s) | $322 | $346 | -7% | 99% | 114 | 170 | |
| CPT 43274 Ercp duct stent placement | $683 | $739 | -8% | 170% | 114 | 211 | |
| CPT 43276 Ercp stent exchange w/dilate | $712 | $771 | -8% | 170% | 114 | 210 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $77 | $84 | -8% | 112% | 115 | 206 | |
| CPT 96413 Chemo iv infusion 1 hr | $184 | $204 | -10% | 138% | 114 | 211 | |
| CPT 45384 Colonoscopy w/lesion removal | $467 | $519 | -10% | 230% | 114 | 164 | |
| CPT 43246 Egd place gastrostomy tube | $303 | $338 | -10% | 170% | 115 | 195 | |
| CPT 43238 Egd us fine needle bx/aspir | $343 | $383 | -10% | 168% | 114 | 209 | |
| CPT 45390 Colonoscopy w/resection | $472 | $532 | -11% | 163% | 112 | 198 | |
| CPT 43259 Egd us exam duodenum/jejunum | $341 | $384 | -11% | 172% | 114 | 196 | |
| CPT 43237 Endoscopic us exam esoph | $281 | $318 | -12% | 163% | 114 | 211 |
Frequently asked questions
How do Pennsylvania gastroenterology rates compare with the rest of the country?
Pennsylvania ranks 26th of 50 states with an index of 98; 16 of 36 codes are above the national median.
Which gastroenterology code has the biggest premium in Pennsylvania?
CPT 99212 (Office o/p est sf 10 min), at 118% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
How these numbers are calculated
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Pennsylvania gastroenterology contracts
Compare your rates with these medians.