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Upper Endoscopy With Bile Duct Stone Breakup

Ohio 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?

$3,388

Typical facility fee. In Ohio, July 2026.

Insurers have agreed to pay about $3,388 for this service. Most negotiated rates run $1,905 to $5,248.

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 $3,388 · 10th to 90th $776 to $12,023
$500$1K$2K$5K$10K$20Kfacility $3,388

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
$645.65
Median
$3,311.31
Typical High
$10,715.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$3,388.44
Typical High
$16,982.44
CareSource
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$446.68
Typical High
$3,388.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$676.08
Typical High
$4,570.88
Cigna
Setting
Facility
Modifier
22 · Increased work
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$724.44
Typical High
$4,570.88
Medical Mutual of Ohio
Setting
Facility
Modifier
22 · Increased work
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$9,332.54
Median
$9,332.54
Typical High
$9,332.54
United
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$4,570.88
Typical High
$8,128.31

Where Ohio 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.

Ohio· 22nd of 50

$3,388

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.