43775

Partial removal of stomach for weight loss using an endoscope

Medicare pricing data for 2,366 providers across 47 states

🤖AI Overview

This procedure has a 7.0x markup — hospitals charge $5,087 but Medicare allows only $728.02. Uninsured patients may face bills 7.0 times higher than what insurance negotiates. Prices vary significantly by location — from $409 in Rhode Island to $1,100 in District of Columbia. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Partial removal of stomach for weight loss using an endoscope (HCPCS code 43775) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $728.02, but hospitals typically charge $5,087 — a 7.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$145.60

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $728.02, your out-of-pocket cost would be approximately $145.60. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$728.02
Average Hospital Charge
$5,087
Markup Ratio
7.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$5,086.70
Medicare Allowed$728.02
Medicare Payment$578.86

Hospitals charge 7.0x more than what Medicare allows for this procedure. Medicare actually pays $578.86 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$1,100$3,707925+51.2%
Illinois$870$5,19389248+19.6%
Massachusetts$843$3,72985267+15.8%
Connecticut$834$4,5594398+14.6%
New Hampshire$807$5,1332971+10.8%
New York$801$8,982186460+10.0%
Tennessee$794$5,03137110+9.1%
Pennsylvania$779$3,094113262+7.0%
Mississippi$777$3,92225156+6.7%
Maryland$776$3,08343109+6.5%
Colorado$775$3,0093494+6.5%
Florida$770$3,859164519+5.7%
Missouri$766$4,14750162+5.2%
Maine$755$2,3581431+3.8%
South Carolina$753$3,85427130+3.5%
Ohio$741$3,35074199+1.8%
Georgia$741$4,99061189+1.7%
New Jersey$727$22,23583275-0.1%
Virginia$719$3,48456177-1.2%
California$713$4,688183619-2.1%
West Virginia$712$4,8851239-2.2%
Oklahoma$711$2,3612483-2.3%
New Mexico$709$2,157818-2.6%
Michigan$705$2,95593301-3.2%
North Carolina$704$4,23475185-3.3%
Oregon$703$3,33432125-3.5%
Texas$701$4,906180615-3.7%
Louisiana$700$4,53342144-3.8%
Nevada$700$4,9222189-3.8%
Wisconsin$700$10,3904798-3.9%
Kentucky$693$3,14939158-4.8%
Delaware$690$4,2631219-5.3%
Alabama$687$3,96640101-5.6%
Arkansas$664$2,98124146-8.9%
Minnesota$658$4,82939128-9.6%
Arizona$649$3,71136104-10.9%
Washington$636$2,92439101-12.6%
Indiana$617$3,36052117-15.3%
Iowa$600$3,7682279-17.5%
Nebraska$591$3,0022149-18.8%
South Dakota$570$3,4011551-21.7%
Kansas$568$3,0022397-22.0%
Montana$538$1,454525-26.1%
Utah$535$3,8942250-26.5%
Idaho$524$3,0861884-28.0%
Alaska$506$13,185317-30.5%
Rhode Island$409$2,125822-43.8%

⚠️ 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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