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Upper Endoscopy With Bile Duct Stone Breakup

Nationwide rates for HCPCS 43265

A flexible scope is passed through the mouth to the opening of the bile and pancreatic ducts, and a stone that is too large or too wedged to pull out whole is broken into pieces first. The fragments are then removed or allowed to pass. Dye and X-ray pictures are used to find the stone and confirm the duct is clear.

Rates data updated July 2026.

How much does Upper Endoscopy With Bile Duct Stone Breakup cost?

$4,570

Typical total for the visit. Nationwide, July 2026.

Insurers have agreed to pay about $4,570 for this procedure. That total is two separate charges: $589 to the doctor who performs it, and $3,981 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 57 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$589$417 to $912
Facility feeThe hospital or surgery center$3,981$1,288 to $7,413

How much rates vary

Facilitymedian $3,981 · 10th to 90th $617 to $12,303Professionalmedian $589 · 10th to 90th $380 to $2,239
$200$500$1K$2K$5K$10K$20Kfacility $3,981professional $589

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
$724.44
Median
$3,715.35
Typical High
$10,471.29
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$6,456.54
Typical High
$14,125.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$1,659.59
Typical High
$8,128.31
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$4,365.16
Typical High
$11,220.18

What it costs in each state

The same service costs 6.6 times more in Wisconsin than in Virginia. 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

Touch or drag across the chart to see any state's rate.

WI $9,020VA $1,361

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.