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Upper Endoscopy With Bile Duct Stone Breakup

Massachusetts 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?

$2,692

Typical facility fee. In Massachusetts, July 2026.

Insurers have agreed to pay about $2,692 for this service. Most negotiated rates run $1,514 to $3,715.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,692 · 10th to 90th $457 to $6,918
$500$1K$2K$5K$10K$20Kfacility $2,692

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
$2,818.38
Typical High
$5,128.61
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$4,365.16
Typical High
$28,840.32
Cigna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$645.65
Typical High
$6,025.60
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$537.03
Typical High
$3,311.31
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$3,801.89
Typical High
$9,772.37
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$4,365.16
Typical High
$28,840.32
United
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$3,890.45
Typical High
$12,302.69

Where Massachusetts 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.

Massachusetts· 27th of 50

$2,692

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.