Removal of stone or debris from bile or pancreatic duct using a flexible endoscope
Medicare pricing data for 4,558 providers across 52 states
This procedure has a 10.3x markup — hospitals charge $1,657 but Medicare allows only $161.05. Uninsured patients may face bills 10.3 times higher than what insurance negotiates. Prices vary significantly by location — from $82 in District of Columbia to $308 in Puerto Rico. 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
Removal of stone or debris from bile or pancreatic duct using a flexible endoscope (HCPCS code 43264) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $161.05, but hospitals typically charge $1,657 — a 10.3x 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 $161.05, your out-of-pocket cost would be approximately $32.21. 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 10.3x more than what Medicare allows for this procedure. Medicare actually pays $127.42 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Puerto Rico | $308 | $691 | 5 | 12 | +91.0% |
| Alaska | $299 | $3,665 | 9 | 128 | +85.4% |
| Vermont | $282 | $2,108 | 6 | 74 | +75.2% |
| Nevada | $238 | $1,175 | 27 | 259 | +47.9% |
| Rhode Island | $224 | $1,590 | 19 | 137 | +39.2% |
| Mississippi | $222 | $1,492 | 36 | 291 | +38.0% |
| Montana | $212 | $1,262 | 19 | 194 | +31.7% |
| Arkansas | $207 | $1,699 | 44 | 460 | +28.4% |
| New Hampshire | $202 | $5,604 | 26 | 287 | +25.2% |
| Oregon | $192 | $1,339 | 67 | 473 | +19.0% |
| Massachusetts | $184 | $1,641 | 98 | 1,917 | +14.1% |
| Idaho | $184 | $883 | 34 | 296 | +14.0% |
| New York | $183 | $2,135 | 237 | 2,827 | +13.8% |
| Iowa | $183 | $2,109 | 29 | 395 | +13.4% |
| Delaware | $182 | $840 | 9 | 199 | +13.2% |
| Florida | $182 | $1,292 | 352 | 3,034 | +12.8% |
| Tennessee | $181 | $1,554 | 105 | 1,066 | +12.5% |
| Georgia | $180 | $1,440 | 141 | 1,041 | +11.8% |
| Connecticut | $180 | $2,073 | 56 | 560 | +11.6% |
| Nebraska | $179 | $1,406 | 30 | 457 | +11.2% |
| Louisiana | $178 | $1,427 | 86 | 701 | +10.7% |
| Pennsylvania | $175 | $1,577 | 246 | 2,632 | +8.5% |
| California | $175 | $1,611 | 467 | 5,094 | +8.4% |
| New Mexico | $174 | $1,372 | 15 | 170 | +8.1% |
| Hawaii | $170 | $945 | 16 | 101 | +5.5% |
| Maryland | $170 | $1,566 | 64 | 847 | +5.3% |
| Wisconsin | $169 | $3,578 | 100 | 1,022 | +4.6% |
| Kansas | $167 | $1,190 | 32 | 449 | +3.8% |
| New Jersey | $164 | $2,420 | 149 | 1,471 | +1.6% |
| Texas | $164 | $1,591 | 417 | 3,887 | +1.5% |
| Utah | $163 | $1,160 | 28 | 345 | +0.9% |
| Ohio | $158 | $1,514 | 143 | 1,602 | -1.7% |
| Illinois | $156 | $2,074 | 176 | 2,479 | -2.9% |
| Michigan | $155 | $1,234 | 165 | 1,670 | -3.9% |
| Oklahoma | $154 | $1,720 | 42 | 598 | -4.2% |
| Alabama | $154 | $1,642 | 50 | 527 | -4.4% |
| Maine | $148 | $1,650 | 14 | 201 | -8.2% |
| Indiana | $148 | $1,719 | 103 | 1,354 | -8.4% |
| South Carolina | $147 | $1,891 | 73 | 926 | -9.0% |
| Arizona | $144 | $1,272 | 83 | 1,212 | -10.6% |
| North Carolina | $141 | $1,552 | 133 | 1,657 | -12.3% |
| Minnesota | $139 | $1,583 | 56 | 1,236 | -13.9% |
| Washington | $132 | $1,245 | 88 | 1,652 | -17.8% |
| North Dakota | $128 | $1,581 | 11 | 237 | -20.3% |
| Colorado | $127 | $1,688 | 85 | 1,137 | -21.0% |
| West Virginia | $121 | $1,391 | 25 | 520 | -24.9% |
| Virginia | $117 | $1,288 | 106 | 1,601 | -27.5% |
| Kentucky | $112 | $1,200 | 67 | 993 | -30.6% |
| Missouri | $109 | $1,632 | 111 | 1,992 | -32.3% |
| South Dakota | $104 | $932 | 9 | 231 | -35.4% |
| Wyoming | $102 | $3,511 | 8 | 50 | -36.8% |
| District of Columbia | $82 | $1,242 | 11 | 376 | -49.4% |
⚠️ 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