Repair of hernia of muscle at esophagus and stomach using an endoscope
Medicare pricing data for 4,783 providers across 50 states
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
Repair of hernia of muscle at esophagus and stomach using an endoscope (HCPCS code 43281) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,121, but hospitals typically charge $4,911 — a 4.4x 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 $1,121, your out-of-pocket cost would be approximately $224.28. 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 4.4x more than what Medicare allows for this procedure. Medicare actually pays $893.02 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $1,428 | $4,869 | 15 | 55 | +27.4% |
| Maryland | $1,384 | $4,241 | 62 | 237 | +23.4% |
| Alaska | $1,321 | $10,900 | 11 | 41 | +17.8% |
| Virginia | $1,310 | $3,922 | 100 | 371 | +16.8% |
| Hawaii | $1,297 | $3,574 | 9 | 15 | +15.6% |
| Maine | $1,262 | $3,577 | 20 | 45 | +12.5% |
| Massachusetts | $1,251 | $5,404 | 148 | 553 | +11.6% |
| South Carolina | $1,243 | $5,557 | 71 | 294 | +10.8% |
| Illinois | $1,231 | $5,898 | 161 | 505 | +9.8% |
| Connecticut | $1,225 | $5,706 | 73 | 202 | +9.2% |
| Ohio | $1,220 | $4,578 | 165 | 483 | +8.8% |
| New York | $1,207 | $6,446 | 285 | 858 | +7.6% |
| Texas | $1,203 | $5,086 | 356 | 1,410 | +7.2% |
| Pennsylvania | $1,191 | $4,676 | 227 | 734 | +6.2% |
| Michigan | $1,187 | $3,565 | 154 | 423 | +5.9% |
| West Virginia | $1,167 | $4,056 | 31 | 133 | +4.1% |
| Louisiana | $1,167 | $4,356 | 68 | 275 | +4.1% |
| Tennessee | $1,165 | $5,179 | 104 | 371 | +3.9% |
| New Jersey | $1,148 | $10,556 | 108 | 349 | +2.4% |
| Kentucky | $1,140 | $3,367 | 75 | 201 | +1.7% |
| Montana | $1,139 | $3,635 | 33 | 92 | +1.6% |
| Florida | $1,128 | $4,682 | 367 | 1,438 | +0.6% |
| California | $1,119 | $4,810 | 375 | 1,534 | -0.2% |
| Colorado | $1,112 | $3,787 | 85 | 218 | -0.9% |
| Wisconsin | $1,097 | $11,612 | 86 | 232 | -2.2% |
| Georgia | $1,092 | $4,984 | 130 | 408 | -2.6% |
| Delaware | $1,090 | $2,773 | 24 | 56 | -2.8% |
| Oklahoma | $1,080 | $3,309 | 57 | 153 | -3.7% |
| Mississippi | $1,071 | $3,454 | 51 | 173 | -4.5% |
| Arkansas | $1,068 | $3,435 | 54 | 187 | -4.7% |
| Alabama | $1,063 | $3,124 | 76 | 231 | -5.2% |
| New Mexico | $1,040 | $4,294 | 28 | 72 | -7.3% |
| New Hampshire | $1,039 | $9,264 | 45 | 173 | -7.3% |
| Oregon | $1,036 | $4,472 | 72 | 258 | -7.6% |
| Minnesota | $1,030 | $6,261 | 70 | 263 | -8.2% |
| Rhode Island | $1,029 | $3,631 | 14 | 31 | -8.2% |
| Washington | $1,022 | $3,818 | 111 | 452 | -8.8% |
| North Carolina | $1,020 | $4,155 | 150 | 433 | -9.0% |
| Indiana | $1,012 | $3,560 | 119 | 370 | -9.7% |
| North Dakota | $1,009 | $3,813 | 21 | 62 | -10.1% |
| Kansas | $973 | $3,378 | 64 | 227 | -13.2% |
| Missouri | $970 | $4,406 | 103 | 533 | -13.5% |
| Utah | $936 | $3,323 | 62 | 196 | -16.5% |
| Nevada | $928 | $5,376 | 32 | 96 | -17.2% |
| Arizona | $916 | $4,051 | 103 | 408 | -18.3% |
| Iowa | $896 | $3,658 | 55 | 228 | -20.1% |
| Idaho | $861 | $3,707 | 41 | 133 | -23.2% |
| South Dakota | $857 | $3,467 | 26 | 126 | -23.6% |
| Wyoming | $831 | $11,274 | 4 | 31 | -25.9% |
| Nebraska | $771 | $4,113 | 47 | 218 | -31.2% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
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