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Upper Endoscopy With Bile Duct Stone Breakup

Washington, DC 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?

$3,548

Typical facility fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $3,548 for this service. Most negotiated rates run $1,698 to $4,571.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $4,074 · 10th to 90th $490 to $7,762Professionalmedian $407 · 10th to 90th $389 to $955
$500$1K$2K$5K$10K$20Kfacility $4,074professional $407

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$3,548.13
Typical High
$7,762.47
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$407.38
Typical High
$954.99
United
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$10,000.00
Typical High
$31,622.78

Where Washington, DC 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.

Washington, DC· 21st of 50

$3,548

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.