Insertion of guide wire with dilation of esophagus using a flexible endoscope
Medicare pricing data for 7,750 providers across 50 states
This procedure has a 6.0x markup — hospitals charge $1,246 but Medicare allows only $207.44. Uninsured patients may face bills 6.0 times higher than what insurance negotiates. 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
Insertion of guide wire with dilation of esophagus using a flexible endoscope (HCPCS code 43248) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $207.44, but hospitals typically charge $1,246 — a 6.0x 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 $207.44, your out-of-pocket cost would be approximately $41.49. 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 6.0x more than what Medicare allows for this procedure. Medicare actually pays $162.06 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $286 | $2,209 | 19 | 288 | +37.8% |
| Delaware | $252 | $1,164 | 17 | 199 | +21.6% |
| California | $245 | $1,401 | 479 | 5,505 | +17.9% |
| Maryland | $241 | $990 | 147 | 1,996 | +16.2% |
| Nevada | $239 | $1,065 | 43 | 1,309 | +15.4% |
| New Jersey | $237 | $2,136 | 142 | 822 | +14.0% |
| Rhode Island | $233 | $1,381 | 45 | 685 | +12.4% |
| Colorado | $232 | $2,066 | 193 | 3,793 | +11.8% |
| Washington | $227 | $921 | 268 | 4,884 | +9.3% |
| New Mexico | $226 | $1,675 | 32 | 557 | +8.9% |
| Georgia | $222 | $1,225 | 278 | 6,034 | +7.2% |
| North Carolina | $222 | $942 | 317 | 5,911 | +7.2% |
| Florida | $222 | $1,188 | 630 | 14,067 | +6.9% |
| Oregon | $219 | $1,583 | 137 | 1,465 | +5.4% |
| Wyoming | $217 | $1,816 | 20 | 1,229 | +4.4% |
| Arizona | $215 | $1,004 | 166 | 2,685 | +3.8% |
| Idaho | $212 | $715 | 61 | 2,781 | +2.4% |
| Indiana | $212 | $1,608 | 187 | 3,325 | +2.3% |
| Vermont | $212 | $1,669 | 7 | 22 | +2.2% |
| North Dakota | $210 | $891 | 16 | 215 | +1.4% |
| Nebraska | $209 | $1,104 | 40 | 526 | +0.5% |
| Pennsylvania | $207 | $888 | 434 | 5,707 | -0.0% |
| Michigan | $204 | $756 | 241 | 2,372 | -1.7% |
| South Carolina | $203 | $1,213 | 143 | 3,486 | -2.2% |
| South Dakota | $202 | $1,312 | 18 | 411 | -2.7% |
| Ohio | $199 | $1,013 | 327 | 3,969 | -4.1% |
| Louisiana | $199 | $1,019 | 157 | 2,961 | -4.1% |
| Virginia | $198 | $974 | 214 | 2,432 | -4.6% |
| Kansas | $197 | $1,639 | 74 | 871 | -5.0% |
| Texas | $196 | $1,798 | 618 | 11,111 | -5.6% |
| Mississippi | $195 | $1,410 | 99 | 4,772 | -6.1% |
| Tennessee | $194 | $1,261 | 252 | 6,250 | -6.5% |
| Alabama | $193 | $1,105 | 129 | 2,059 | -6.8% |
| New York | $193 | $1,056 | 222 | 1,471 | -6.8% |
| West Virginia | $190 | $627 | 30 | 205 | -8.2% |
| Minnesota | $190 | $978 | 206 | 1,503 | -8.3% |
| Utah | $185 | $1,108 | 26 | 300 | -10.9% |
| Maine | $184 | $636 | 36 | 279 | -11.3% |
| Missouri | $183 | $1,167 | 174 | 3,043 | -11.9% |
| Montana | $182 | $928 | 19 | 231 | -12.3% |
| District of Columbia | $181 | $714 | 28 | 107 | -12.5% |
| Arkansas | $181 | $786 | 55 | 1,207 | -12.6% |
| Illinois | $174 | $1,560 | 275 | 3,403 | -16.3% |
| Iowa | $173 | $1,278 | 56 | 850 | -16.4% |
| Massachusetts | $173 | $908 | 164 | 1,075 | -16.7% |
| Oklahoma | $171 | $782 | 80 | 1,991 | -17.4% |
| Kentucky | $168 | $650 | 102 | 2,011 | -19.2% |
| Wisconsin | $166 | $1,928 | 182 | 2,176 | -20.1% |
| Connecticut | $165 | $1,056 | 60 | 242 | -20.6% |
| New Hampshire | $157 | $1,648 | 38 | 211 | -24.5% |
⚠️ 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