43450

Dilation of esophagus

Medicare pricing data for 4,051 providers across 49 states

🤖AI Overview

This procedure has a 5.6x markup — hospitals charge $824.87 but Medicare allows only $147.77. Uninsured patients may face bills 5.6 times higher than what insurance negotiates. Prices vary significantly by location — from $38 in North Dakota to $272 in New Mexico. 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

Dilation of esophagus (HCPCS code 43450) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $147.77, but hospitals typically charge $824.87 — a 5.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$29.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $147.77, your out-of-pocket cost would be approximately $29.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$147.77
Average Hospital Charge
$824.87
Markup Ratio
5.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$824.87
Medicare Allowed$147.77
Medicare Payment$117.71

Hospitals charge 5.6x more than what Medicare allows for this procedure. Medicare actually pays $117.71 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Mexico$272$991948+83.9%
Hawaii$204$1,633832+38.1%
California$201$1,0402213,295+36.1%
Nevada$201$1,06225286+35.9%
Washington$194$1,5842268+31.1%
Maryland$192$726811,083+29.8%
Minnesota$183$65928211+23.6%
New Jersey$172$2,218921,139+16.6%
Tennessee$171$6901686,461+15.6%
Rhode Island$170$784895+15.3%
Arizona$170$1,536721,087+15.2%
South Carolina$168$6021367,488+13.7%
Pennsylvania$167$6882683,638+13.2%
Georgia$161$6571442,418+9.0%
Utah$159$885401,130+7.5%
Nebraska$158$851511,321+6.8%
Ohio$156$6712134,233+5.4%
Florida$155$9033487,304+5.1%
Louisiana$155$6071084,737+4.9%
Delaware$154$72826372+4.4%
Idaho$152$50025207+3.1%
Iowa$152$1,26432320+3.0%
Colorado$149$5,57549608+1.1%
Oklahoma$149$594421,123+0.6%
North Carolina$148$6582104,671-0.1%
Michigan$147$6911723,131-0.7%
New York$144$8431341,616-2.8%
Texas$142$1,2462734,362-4.0%
Missouri$134$1,176921,812-9.3%
Kansas$131$861691,964-11.5%
Mississippi$126$641513,057-14.5%
Illinois$116$748801,446-21.7%
Oregon$115$47525262-22.4%
Alabama$111$1,139911,856-24.8%
Kentucky$110$528691,425-25.5%
Massachusetts$108$62861529-26.8%
Wisconsin$104$1,00448341-29.7%
Indiana$99$6841092,404-33.2%
Arkansas$81$406441,870-44.9%
Connecticut$76$66142260-48.9%
New Hampshire$64$1,0391176-56.6%
Virginia$64$5421211,616-56.8%
Montana$63$279846-57.4%
District of Columbia$59$502713-60.4%
West Virginia$43$30932457-71.0%
South Dakota$42$32814100-71.6%
Vermont$40$386420-73.0%
Maine$39$21121146-73.4%
North Dakota$38$1,007790-74.1%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber