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Upper Endoscopy With Bile Duct Stone Breakup

Illinois 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?

$1,862

Typical facility fee. In Illinois, July 2026.

Insurers have agreed to pay about $1,862 for this service. Most negotiated rates run $832 to $4,169.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,399 · 10th to 90th $724 to $9,333Professionalmedian $776 · 10th to 90th $457 to $2,951
$200$500$1K$2K$5K$10Kfacility $2,399professional $776

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
$602.56
Median
$1,862.09
Typical High
$9,332.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$7,762.47
Typical High
$10,471.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$5,248.07
Typical High
$10,000.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$776.25
Typical High
$2,951.21
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$4,365.16
Typical High
$8,511.38

Where Illinois 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.

Illinois· 33rd of 50

$1,862

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.