Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm
Medicare pricing data for 14,268 providers across 51 states
This procedure has a 6.0x markup — hospitals charge $1,725 but Medicare allows only $286.15. Uninsured patients may face bills 6.0 times higher than what insurance negotiates. Prices vary significantly by location — from $145 in District of Columbia to $376 in Nevada. 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
Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm (HCPCS code 43249) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $286.15, but hospitals typically charge $1,725 — 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 $286.15, your out-of-pocket cost would be approximately $57.23. 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 $225.25 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Nevada | $376 | $2,504 | 85 | 1,069 | +31.3% |
| Wyoming | $359 | $1,794 | 32 | 556 | +25.5% |
| California | $357 | $2,342 | 1,143 | 10,750 | +24.7% |
| Hawaii | $342 | $2,025 | 37 | 156 | +19.7% |
| Arizona | $338 | $1,363 | 266 | 3,239 | +18.2% |
| Florida | $337 | $1,786 | 1,016 | 13,819 | +17.7% |
| New Jersey | $334 | $2,875 | 376 | 2,062 | +16.7% |
| Arkansas | $332 | $1,302 | 141 | 2,937 | +16.2% |
| New York | $330 | $2,081 | 659 | 3,757 | +15.2% |
| Alaska | $329 | $3,040 | 41 | 199 | +15.0% |
| Virginia | $324 | $1,832 | 416 | 4,380 | +13.3% |
| Maryland | $322 | $1,605 | 241 | 2,648 | +12.5% |
| Texas | $322 | $2,052 | 1,096 | 13,396 | +12.5% |
| Illinois | $308 | $1,903 | 574 | 5,689 | +7.6% |
| North Carolina | $305 | $1,441 | 545 | 7,603 | +6.6% |
| Delaware | $303 | $1,366 | 54 | 608 | +5.8% |
| Colorado | $301 | $2,500 | 248 | 2,874 | +5.3% |
| Oregon | $289 | $2,331 | 189 | 1,201 | +1.0% |
| Connecticut | $285 | $1,553 | 208 | 1,157 | -0.3% |
| Iowa | $283 | $2,032 | 130 | 2,517 | -1.0% |
| Louisiana | $283 | $1,158 | 201 | 2,235 | -1.1% |
| Mississippi | $276 | $1,991 | 114 | 1,546 | -3.7% |
| Georgia | $270 | $1,605 | 439 | 5,115 | -5.6% |
| Ohio | $269 | $1,235 | 638 | 6,608 | -6.0% |
| Rhode Island | $269 | $1,607 | 51 | 435 | -6.1% |
| Utah | $268 | $2,344 | 119 | 3,302 | -6.5% |
| Tennessee | $267 | $1,535 | 303 | 3,747 | -6.6% |
| New Mexico | $264 | $1,046 | 56 | 631 | -7.6% |
| Alabama | $263 | $1,476 | 236 | 5,605 | -7.9% |
| Kentucky | $257 | $1,256 | 249 | 3,892 | -10.1% |
| Michigan | $257 | $933 | 444 | 3,273 | -10.1% |
| Kansas | $256 | $1,765 | 147 | 2,254 | -10.5% |
| Washington | $254 | $1,447 | 356 | 2,685 | -11.2% |
| Massachusetts | $247 | $1,539 | 446 | 3,353 | -13.7% |
| South Carolina | $239 | $1,264 | 233 | 3,490 | -16.3% |
| Oklahoma | $234 | $1,004 | 180 | 3,456 | -18.3% |
| Missouri | $226 | $1,478 | 354 | 4,845 | -21.0% |
| Minnesota | $225 | $1,765 | 298 | 2,006 | -21.3% |
| Vermont | $224 | $1,969 | 25 | 235 | -21.7% |
| Pennsylvania | $219 | $997 | 664 | 3,753 | -23.4% |
| New Hampshire | $212 | $1,779 | 95 | 1,442 | -26.0% |
| Indiana | $212 | $1,824 | 290 | 3,476 | -26.1% |
| Idaho | $205 | $667 | 74 | 990 | -28.5% |
| Nebraska | $199 | $2,367 | 104 | 1,484 | -30.6% |
| Wisconsin | $195 | $3,026 | 316 | 2,915 | -31.8% |
| Montana | $193 | $738 | 36 | 989 | -32.7% |
| Maine | $191 | $867 | 55 | 615 | -33.3% |
| South Dakota | $166 | $1,788 | 57 | 515 | -42.1% |
| West Virginia | $162 | $818 | 70 | 642 | -43.2% |
| North Dakota | $150 | $2,034 | 36 | 526 | -47.6% |
| District of Columbia | $145 | $857 | 32 | 123 | -49.3% |
⚠️ 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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