Dilation of stomach outlet using a flexible endoscope
Medicare pricing data for 5,223 providers across 50 states
This procedure has a 6.0x markup — hospitals charge $1,311 but Medicare allows only $219.64. Uninsured patients may face bills 6.0 times higher than what insurance negotiates. Prices vary significantly by location — from $136 in West Virginia to $493 in Wyoming. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Dilation of stomach outlet using a flexible endoscope (HCPCS code 43245) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $219.64, but hospitals typically charge $1,311 — a 6.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $219.64, your out-of-pocket cost would be approximately $43.93. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 6.0x more than what Medicare allows for this procedure. Medicare actually pays $172.03 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Wyoming | $493 | $1,787 | 16 | 82 | +124.2% |
| Alaska | $328 | $2,343 | 16 | 32 | +49.3% |
| Mississippi | $303 | $1,461 | 76 | 277 | +37.8% |
| Hawaii | $285 | $1,831 | 10 | 16 | +29.8% |
| California | $279 | $2,017 | 382 | 1,085 | +27.0% |
| Louisiana | $260 | $1,182 | 102 | 288 | +18.2% |
| Nevada | $254 | $1,157 | 41 | 94 | +15.4% |
| Colorado | $243 | $2,053 | 117 | 296 | +10.5% |
| Ohio | $239 | $1,132 | 229 | 549 | +9.0% |
| Florida | $238 | $1,139 | 358 | 914 | +8.5% |
| South Carolina | $235 | $972 | 116 | 317 | +7.1% |
| Tennessee | $233 | $1,270 | 131 | 331 | +6.3% |
| Kansas | $233 | $1,543 | 70 | 181 | +6.1% |
| Utah | $232 | $1,604 | 62 | 253 | +5.6% |
| Texas | $229 | $1,443 | 400 | 975 | +4.0% |
| Oklahoma | $226 | $906 | 88 | 263 | +3.0% |
| Oregon | $224 | $1,546 | 86 | 165 | +2.2% |
| Washington | $223 | $1,086 | 134 | 337 | +1.4% |
| Connecticut | $219 | $1,170 | 49 | 87 | -0.1% |
| Maryland | $218 | $1,424 | 109 | 231 | -0.8% |
| North Carolina | $216 | $1,027 | 206 | 492 | -1.6% |
| Georgia | $216 | $1,136 | 151 | 307 | -1.8% |
| Iowa | $215 | $1,737 | 50 | 153 | -2.2% |
| Arizona | $215 | $1,039 | 123 | 376 | -2.2% |
| New Jersey | $210 | $1,915 | 104 | 201 | -4.3% |
| Montana | $203 | $808 | 22 | 74 | -7.8% |
| North Dakota | $202 | $1,359 | 19 | 78 | -7.8% |
| Michigan | $201 | $821 | 151 | 447 | -8.3% |
| Arkansas | $201 | $890 | 68 | 201 | -8.4% |
| Indiana | $201 | $1,491 | 132 | 336 | -8.7% |
| Delaware | $198 | $931 | 16 | 27 | -10.0% |
| Alabama | $198 | $983 | 108 | 316 | -10.1% |
| Illinois | $197 | $1,431 | 185 | 440 | -10.3% |
| Minnesota | $191 | $1,298 | 112 | 218 | -13.0% |
| Pennsylvania | $190 | $879 | 253 | 633 | -13.5% |
| Idaho | $190 | $851 | 51 | 259 | -13.7% |
| New York | $189 | $1,630 | 155 | 308 | -14.0% |
| Missouri | $183 | $1,126 | 140 | 368 | -16.9% |
| Kentucky | $181 | $793 | 91 | 303 | -17.7% |
| Wisconsin | $180 | $2,603 | 81 | 163 | -18.2% |
| Rhode Island | $178 | $1,415 | 10 | 19 | -18.8% |
| Maine | $174 | $804 | 14 | 31 | -21.0% |
| New Mexico | $173 | $978 | 18 | 33 | -21.3% |
| District of Columbia | $165 | $1,165 | 10 | 14 | -24.7% |
| Massachusetts | $165 | $1,175 | 97 | 201 | -25.1% |
| Virginia | $162 | $1,146 | 130 | 291 | -26.0% |
| New Hampshire | $158 | $3,133 | 30 | 62 | -28.3% |
| Nebraska | $155 | $1,374 | 47 | 310 | -29.6% |
| South Dakota | $148 | $1,118 | 26 | 78 | -32.7% |
| West Virginia | $136 | $785 | 27 | 102 | -38.2% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber