go back

Upper Endoscopy With Bile Duct Stone Breakup

Pennsylvania 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?

$3,890

Typical facility fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $3,890 for this service. Most negotiated rates run $2,188 to $7,244.

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 9 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $3,890 · 10th to 90th $955 to $8,710
$500$1K$2K$5K$10K$20Kfacility $3,890

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
$1,023.29
Median
$4,073.80
Typical High
$8,511.38
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$6,165.95
Typical High
$57,543.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$3,801.89
Typical High
$7,585.78
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
$851.14
Median
$851.14
Typical High
$851.14
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$4,073.80
Typical High
$4,786.30
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,677.35
Median
$15,848.93
Typical High
$36,307.81
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$3,890.45
Typical High
$9,549.93
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,698.24
Typical High
$2,951.21
United
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$3,311.31
Typical High
$17,782.79

Where Pennsylvania 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.

Pennsylvania· 17th of 50

$3,890

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.