Downloadable notice on Indiana price transparency requirements:

Indiana Notice Regarding Surprise Billing and Good Faith Estimate.pdf

PROCEDURE OPTION CODE FACILITY PHYSICIAN
ESOPHAGUS ENDOSCOPY 43200 $1,082 $1,048
UPPR GI ENODOSCOPY 43235 $1,082 $1,075
UPPER GI SCOPY W/SUB INJ 43236 $1,391 $1,310
UPPER GI ENDO W/BIOPSY 43239 $1,391 $1,263
UPPER GI DILATE STRIC 43245 $1,391 $1,350
OPER UPPER GI ENDO 43247 $1,391 $1,272
UPPER GI GUIDWIRE DILATION 43248 $1,391 $1,250
ESOPH ENDOSCOPY, DILATION 43249 $1,391 $1,154
UPPER GI ENDO W/TUMOR 43250 $1,391 $1,200
UPPER GI POLYP REMOVAL 43251 $1,391 $1,448
UPPER GI W/CAUTERY 43255 $1,391 $1,376
UPPER GI ABLATION OF TUMOR 43270 $1,391 $1,600
UPPER GI MALONEY DILATION 43450 $1,082 $500
SMALL BOWEL ENDOSCOPY 44360 $1,391 $1,203
SM BOWEL POUCH/BIOPSY 44386 $1,391 $1,240
COLONOSCOPY 44388 $1,391 $1,344
COLONOSCOPY W/SNARE W/SNARE 44394 $1,391 $1,808
DIAGNOSTIC SIGMOIDOSCOPY 45330 $1,082 $489
SIGMOIDOSCOY W/BIOPSY 45331 $1,391 $637
SIGMOIDOSCOPY FOR BLEED 45334 $1,082 $906
SIGMOIDOSCOY W/ TUMOR 45338 $1,391 $965
DIAGNOSTIC COLONOSCOPY 45378 $1,391 $1,500
COLONOSCOPY W/BIOPSY 45380 $1,391 $1,600
COLONOSCOPY, SUB INJ 45381 $1,391 $1,750
COLONOSCOPY CONTROL BLEED 45382 $1,391 $1,900
COLON LESION REMOVAL 45384 $1,391 $1,900
COLON W/POLYP REMOVAL 45385 $1,391 $1,950
COLON DILATION STRICTURE 45386 $1,391 $1,900
COLON BALLOON DILATION 45388 $1,391 $1,900
ENDOSCOPIC MUCOSAL REMOVAL 45390 $1,391 $2,300
HIGH RISK COLON SCREEN G0105 $1,391 $1,500
LOW RISK COLON SCREEN G0121 $1,391 $1,500

SCREENING COLONOSCOPY CODES

Z12.11-SCREENING EVERY 10 YRS
NO PERSONAL OR FAMILY HISTORY OF POLYPS OR CANCER
NO CURRENT SYMPTOMS
CODE USED EVERY 10 YRS AND MAY BE PAID AT 100%

Z80.0-FAMILY HISTORY OF COLON CANCER
FIRST DEGREE RELATIVE (PARENTS OR SIBLINGS)
*THIS MAY BE CONSIDERED DIAGNOSTIC AND WILL GO TOWARDS DEDUCTIBLE

Z83.71-FAMILY HISTORY OF COLON POLYPS
FIRST DEGREE RELATIVE (PARENTS OR SIBLINGS)
*THIS MAY BE CONSIDERED DIAGNOSTIC AND WILL GO TOWARDS DEDUCTIBLE

Z86.010-PERSONAL HISTORY OF COLON POLYPS
*THIS MAY BE CONSIDERED DIAGNOSTIC AND WILL GO TOWARDS DEDUCTIBLE

We follow Federal Coding Guidelines.

Northside Gastroenterology Endoscopy Center accepts most major insurances. As a courtesy to you, we will bill your insurance carrier for you; however, we cannot tell you what your policy will cover. Since your insurance policy and coverage is between you and your carrier, we urge you to contact them prior to your procedure.

You will be responsible for any co-pays at the time of service. Someone from the center will call you before your procedure with an estimate of what you will need to pay on the day of your appointment.

Northside Gastroenterology Endoscopy Center accepts cash, personal checks, Visa, MasterCard, American Express and Discover.

Billing Information

Most insurances will cover the cost of the procedure, less any co-pays or co-insurance that may apply. Each insurance plan is different, so be sure to check with your provider in advance.

Your procedure will result in separate charges that include:

  • A professional fee – this is the doctor’s charge for performing the procedure.
  • A facility fee – this is the charge from the center.
  • A pathology fee – if a biopsy is needed, you will be billed directly by the lab company.
  • An anesthesia Fee.

If you would like an estimate, please fill out the form below.