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Upper Endoscopy With Bile Duct Stone Breakup

North Carolina 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?

$776

Typical facility fee. In North Carolina, July 2026.

Insurers have agreed to pay about $776 for this service. Most negotiated rates run $513 to $1,585.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $776 · 10th to 90th $427 to $7,586Professionalmedian $933 · 10th to 90th $933 to $933
$500$1K$2K$5K$10Kfacility $776professional $933

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
$426.58
Median
$1,584.89
Typical High
$8,709.64
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$1,778.28
Typical High
$1,995.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$2,754.23
Typical High
$4,897.79
Medcost
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Medcost
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$616.60
Typical High
$1,023.29
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$4,570.88
Typical High
$10,232.93
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$15,848.93
Median
$15,848.93
Typical High
$28,840.32

Where North Carolina 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.

North Carolina· 44th of 50

$776

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.