Control of bleeding of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Medicare pricing data for 11,769 providers across 51 states
This procedure has a 6.0x markup — hospitals charge $1,240 but Medicare allows only $208.19. 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
Control of bleeding of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS code 43255) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $208.19, but hospitals typically charge $1,240 — 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 $208.19, your out-of-pocket cost would be approximately $41.64. 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 $164.59 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $281 | $2,008 | 34 | 134 | +35.0% |
| Hawaii | $238 | $1,087 | 33 | 134 | +14.2% |
| New York | $235 | $1,738 | 798 | 2,907 | +12.9% |
| Rhode Island | $234 | $1,152 | 52 | 188 | +12.3% |
| California | $234 | $1,509 | 1,048 | 5,132 | +12.3% |
| Wyoming | $231 | $1,414 | 20 | 63 | +11.1% |
| New Jersey | $230 | $1,819 | 391 | 1,715 | +10.5% |
| Maryland | $230 | $1,169 | 226 | 1,065 | +10.4% |
| Florida | $226 | $1,017 | 861 | 4,549 | +8.5% |
| Nebraska | $223 | $1,606 | 72 | 724 | +6.9% |
| Mississippi | $222 | $1,269 | 107 | 522 | +6.5% |
| Louisiana | $218 | $1,027 | 182 | 794 | +4.6% |
| Connecticut | $210 | $1,234 | 175 | 556 | +0.7% |
| Washington | $208 | $1,107 | 277 | 1,341 | +0.0% |
| Michigan | $205 | $824 | 345 | 1,626 | -1.5% |
| Oregon | $205 | $1,613 | 142 | 483 | -1.7% |
| Texas | $205 | $1,211 | 842 | 3,752 | -1.7% |
| Alabama | $204 | $1,143 | 157 | 773 | -2.0% |
| Utah | $204 | $1,246 | 75 | 319 | -2.1% |
| Illinois | $203 | $1,469 | 484 | 2,332 | -2.4% |
| Nevada | $202 | $841 | 60 | 371 | -2.8% |
| Colorado | $202 | $954 | 180 | 682 | -2.9% |
| Pennsylvania | $200 | $904 | 632 | 2,209 | -3.8% |
| Massachusetts | $199 | $1,051 | 368 | 1,476 | -4.2% |
| Maine | $199 | $960 | 50 | 197 | -4.3% |
| District of Columbia | $199 | $1,073 | 42 | 159 | -4.4% |
| South Carolina | $198 | $1,099 | 202 | 1,164 | -4.7% |
| Iowa | $198 | $1,456 | 92 | 500 | -4.7% |
| Georgia | $198 | $1,205 | 313 | 1,163 | -4.9% |
| Tennessee | $197 | $1,367 | 236 | 1,312 | -5.6% |
| Arizona | $196 | $834 | 194 | 876 | -5.7% |
| Idaho | $196 | $626 | 53 | 303 | -5.9% |
| North Dakota | $196 | $1,315 | 23 | 273 | -5.9% |
| Kansas | $195 | $1,103 | 99 | 527 | -6.3% |
| Ohio | $195 | $966 | 503 | 1,964 | -6.3% |
| Montana | $194 | $1,022 | 29 | 149 | -6.9% |
| North Carolina | $193 | $1,248 | 405 | 1,595 | -7.3% |
| New Hampshire | $192 | $2,358 | 71 | 301 | -7.7% |
| Delaware | $191 | $1,020 | 36 | 318 | -8.4% |
| Virginia | $189 | $1,035 | 288 | 1,418 | -9.0% |
| Arkansas | $189 | $917 | 89 | 573 | -9.1% |
| New Mexico | $189 | $907 | 36 | 117 | -9.3% |
| Kentucky | $189 | $788 | 160 | 882 | -9.4% |
| Oklahoma | $188 | $888 | 125 | 716 | -9.6% |
| South Dakota | $187 | $1,274 | 33 | 113 | -10.3% |
| Minnesota | $187 | $1,347 | 218 | 789 | -10.3% |
| Missouri | $186 | $1,050 | 278 | 1,494 | -10.5% |
| Wisconsin | $182 | $2,766 | 238 | 876 | -12.4% |
| Indiana | $182 | $1,073 | 234 | 1,476 | -12.6% |
| Vermont | $180 | $1,794 | 16 | 67 | -13.8% |
| West Virginia | $176 | $868 | 55 | 294 | -15.3% |
⚠️ 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