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Upper Endoscopy With Bile Duct Stone Breakup

New York 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?

$5,370

Typical facility fee. In New York, July 2026.

Insurers have agreed to pay about $5,370 for this service. Most negotiated rates run $2,818 to $8,913.

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 10 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $5,370 · 10th to 90th $813 to $12,023
$500$1K$2K$5K$10Kfacility $5,370

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
$588.84
Median
$3,890.45
Typical High
$10,715.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$7,762.47
Typical High
$13,489.63
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,698.24
Typical High
$6,165.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$5,011.87
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$630.96
Typical High
$1,445.44
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$6,606.93
Typical High
$8,128.31
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$50,118.72
Typical High
$75,857.76
United
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$4,365.16
Typical High
$10,964.78
Univera
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$512.86
Typical High
$2,290.87

Where New York 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.

New York· 10th of 50

$5,370

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.