43247

Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using a flexible endoscope

Medicare pricing data for 9,053 providers across 51 states

🤖AI Overview

This procedure has a 5.9x markup — hospitals charge $954.17 but Medicare allows only $160.41. Uninsured patients may face bills 5.9 times higher than what insurance negotiates. 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

Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS code 43247) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $160.41, but hospitals typically charge $954.17 — a 5.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$32.08

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $160.41, your out-of-pocket cost would be approximately $32.08. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$160.41
Average Hospital Charge
$954.17
Markup Ratio
5.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$954.17
Medicare Allowed$160.41
Medicare Payment$123.42

Hospitals charge 5.9x more than what Medicare allows for this procedure. Medicare actually pays $123.42 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$216$2,2582861+34.5%
New York$177$1,2954661,069+10.5%
Wyoming$176$1,2922854+9.9%
Rhode Island$174$8923145+8.5%
New Jersey$172$1,371261576+7.4%
New Mexico$171$7603267+6.6%
Hawaii$171$8471429+6.5%
Maryland$171$883144388+6.3%
Florida$170$8356421,673+5.9%
Louisiana$170$818143288+5.9%
North Dakota$169$1,01225111+5.3%
Connecticut$169$980113210+5.2%
Vermont$168$1,4522046+4.7%
Massachusetts$168$892266619+4.6%
Delaware$168$6943085+4.5%
Kansas$166$881107296+3.4%
Mississippi$166$1,054102242+3.3%
Illinois$165$1,101378957+3.0%
Michigan$165$703295771+2.9%
Nevada$164$89349155+2.4%
Georgia$163$933241528+1.9%
Utah$163$74169166+1.7%
Montana$162$6822873+1.2%
Colorado$162$1,120149365+0.9%
California$162$1,0536952,003+0.7%
Oregon$161$1,054118283+0.3%
Idaho$160$54162146-0.2%
Washington$160$771207559-0.3%
Maine$160$5994081-0.3%
Ohio$157$769395815-1.9%
Texas$156$9776371,692-2.5%
Oklahoma$156$73797287-2.5%
New Hampshire$156$1,76154130-2.7%
Pennsylvania$156$7774851,096-2.9%
North Carolina$156$896290669-2.9%
Arkansas$155$76782214-3.5%
Iowa$155$99193224-3.6%
Missouri$154$790224610-4.3%
South Dakota$153$90238103-4.6%
Wisconsin$153$2,178194402-4.7%
Alabama$153$796141311-4.8%
Kentucky$151$620174456-5.6%
Virginia$150$776215608-6.4%
South Carolina$150$941151411-6.5%
Tennessee$150$824205532-6.5%
Indiana$149$1,112219734-7.4%
West Virginia$145$63059152-9.5%
Arizona$145$643151472-9.7%
Minnesota$144$1,163174523-10.0%
Nebraska$144$95071255-10.1%
District of Columbia$123$52226124-23.5%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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