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Upper Endoscopy With Bile Duct Stone Breakup

California 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?

$5,495

Typical facility fee. In California, July 2026.

Insurers have agreed to pay about $5,495 for this service. Most negotiated rates run $3,311 to $8,318.

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.

How much rates vary

Facilitymedian $5,754 · 10th to 90th $1,202 to $13,804Professionalmedian $437 · 10th to 90th $347 to $1,023
$100$500$2K$10Kfacility $5,754professional $437

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
$2,398.83
Median
$6,456.54
Typical High
$16,982.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,630.78
Median
$6,165.95
Typical High
$13,489.63
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$4,265.80
Typical High
$9,332.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$1,023.29
Typical High
$5,248.07
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$467.74
Typical High
$588.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$426.58
Typical High
$1,023.29
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$15,848.93
Median
$28,840.32
Typical High
$28,840.32
Providence
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$630.96
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$7,244.36
Typical High
$15,135.61

Where California sits

The same service costs 72.4 times more in West Virginia than in North Dakota. 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.

California· 9th of 50

$5,495

WV $31,623ND $437

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.