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Removal of a Pouch From the Esophagus

Pennsylvania rates for HCPCS 43135

Surgery that removes a pouch which has ballooned out through the wall of the esophagus, the tube carrying food from the throat to the stomach. The tight muscle below the pouch, which drove it to form in the first place, is commonly divided during the same operation.

Rates data updated July 2026.

How much does Removal of a Pouch From the Esophagus cost?

$6,884

Typical total for the visit. In Pennsylvania, July 2026.

Insurers have agreed to pay about $6,884 for this procedure. That total is two separate charges: $1,514 to the doctor who performs it, and $5,370 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$1,514$1,413 to $1,738
Facility feeThe hospital or surgery center$5,370$1,549 to $7,762

How much rates vary

Facilitymedian $5,370 · 10th to 90th $1,023 to $8,511Professionalmedian $1,514 · 10th to 90th $1,318 to $2,188
$500$1K$2K$5K$10K$20Kfacility $5,370professional $1,514

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$5,370.32
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,513.56
Typical High
$2,041.74
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$20,417.38
Median
$21,379.62
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,238.72
Typical High
$2,238.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$2,089.30
Typical High
$36,307.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,659.59
Typical High
$2,951.21
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,162.28
Typical High
$3,162.28
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$2,041.74
Typical High
$2,511.89
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,513.56
Typical High
$2,454.71
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$4,786.30
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,513.56
Typical High
$2,884.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,380.38
Typical High
$3,311.31
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$3,630.78
Typical High
$3,801.89
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,445.44
Typical High
$1,584.89
United
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$2,290.87
Typical High
$6,309.57
United
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,621.81
Typical High
$2,818.38

Where Pennsylvania sits

The same service costs 7.1 times more in Maine than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Pennsylvania· 13th of 50

$6,884

$1,514 physician + $5,370 facility

ME $14,165MD $1,985

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.