43276

Replacement of stent in pancreatic or bile duct using a flexible endoscope

Medicare pricing data for 2,391 providers across 49 states

🤖AI Overview

Prices vary significantly by location — from $365 in Minnesota to $1,173 in Alaska. 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

Replacement of stent in pancreatic or bile duct using a flexible endoscope (HCPCS code 43276) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $424.28, but hospitals typically charge $1,930 — a 4.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$84.86

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $424.28, your out-of-pocket cost would be approximately $84.86. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$424.28
Average Hospital Charge
$1,930
Markup Ratio
4.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,929.70
Medicare Allowed$424.28
Medicare Payment$336.00

Hospitals charge 4.5x more than what Medicare allows for this procedure. Medicare actually pays $336.00 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$1,173$6,112518+176.5%
Rhode Island$480$1,357725+13.1%
Delaware$477$1,2241034+12.5%
District of Columbia$477$1,5157125+12.4%
Maryland$474$1,37835197+11.6%
New York$473$2,469145796+11.4%
Nevada$464$1,3021447+9.4%
New Jersey$455$2,58474370+7.2%
New Hampshire$453$7,0001177+6.8%
Illinois$453$2,31895565+6.8%
Utah$442$1,4151565+4.2%
Florida$442$1,680157719+4.1%
New Mexico$440$1,371953+3.7%
Louisiana$437$1,53232160+3.0%
Georgia$434$1,58464259+2.2%
West Virginia$433$1,54816127+2.1%
California$432$1,9552461,987+1.8%
Wisconsin$432$3,40657242+1.8%
Pennsylvania$431$1,910119908+1.7%
Washington$431$1,41560542+1.6%
Arkansas$430$3,06923105+1.3%
Connecticut$429$2,41634341+1.2%
Texas$429$2,1841971,241+1.2%
South Carolina$426$2,04936211+0.4%
Kansas$426$1,24715132+0.3%
Kentucky$424$1,21834224-0.2%
Hawaii$422$1,119727-0.6%
North Carolina$421$1,60968422-0.9%
Maine$419$1,610740-1.4%
Massachusetts$418$2,15763682-1.4%
South Dakota$417$1,065871-1.7%
Mississippi$415$1,5321953-2.1%
Missouri$415$1,66868660-2.3%
Tennessee$414$1,63550191-2.4%
Colorado$413$1,49644343-2.7%
Nebraska$413$1,45519122-2.8%
Idaho$413$1,0611847-2.8%
Alabama$410$1,71227164-3.3%
Ohio$410$1,81387501-3.5%
Oklahoma$402$2,24317126-5.4%
Michigan$399$1,56375608-6.1%
Montana$397$1,3161180-6.4%
North Dakota$396$1,701849-6.8%
Iowa$393$1,73417139-7.3%
Oregon$391$1,58633161-7.8%
Arizona$382$1,91837437-10.0%
Virginia$379$1,37556570-10.7%
Indiana$376$1,75455379-11.3%
Minnesota$365$2,25646603-13.9%

⚠️ 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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