Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope

Medicare Payment (avg)
$206.55
What Medicare actually pays
Billed Charge (avg)
$1,115.82
What providers submit
Markup
5.4x
440% above Medicare rate
18.4K
Total Services
12.0K
Beneficiaries
6.6K
Providers
51
States with Data

Price Range Across States

Lowest State Avg
$163.62
Maine
Highest State Avg
$336.36
Wyoming

What You Might Pay

Est. Commercial Insurance
$595.01
Range: $416.51 – $833.01
Est. Cash / Self-Pay
$506.07
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Digestive Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Wyoming $336.36 $1,711.29
Nevada $290.49 $1,001.48
Alaska $288.44 $1,833.56
Rhode Island $269.78 $1,363.01
Mississippi $254.98 $1,257.03
Louisiana $245.50 $1,143.04
California $240.89 $1,227.75
Kansas $239.16 $1,831.73
Minnesota $219.14 $1,327.92
Colorado $215.62 $1,023.37
Texas $212.97 $1,222.44
Indiana $212.80 $1,822.00
South Dakota $212.63 $799.09
Utah $212.35 $1,385.70
Iowa $212.30 $1,400.14
Florida $212.06 $950.15
Arizona $210.37 $1,009.49
New Jersey $210.05 $1,420.39
New York $208.60 $1,116.11
Illinois $208.37 $1,360.23
District of Columbia $208.13 $873.09
Tennessee $202.96 $1,108.13
Ohio $196.04 $919.72
Washington $195.53 $833.28
Michigan $195.14 $815.24
Massachusetts $195.12 $963.32
Arkansas $194.58 $817.18
Connecticut $192.48 $1,102.93
Maryland $192.32 $840.81
Idaho $190.86 $708.94
Pennsylvania $190.52 $879.53
Georgia $189.73 $926.71
Alabama $187.48 $1,040.45
Wisconsin $186.57 $2,461.40
Delaware $186.42 $589.67
New Hampshire $186.13 $1,808.79
South Carolina $185.47 $999.39
Missouri $183.64 $1,103.39
Oregon $182.36 $855.19
Montana $181.67 $674.03
Virginia $180.01 $815.50
North Carolina $179.07 $941.67
North Dakota $173.85 $1,000.03
West Virginia $173.45 $728.41
Kentucky $173.23 $742.24
New Mexico $171.90 $787.84
Vermont $170.52 $1,247.39
Oklahoma $169.67 $653.97
Nebraska $167.75 $838.05
Hawaii $167.06 $681.72
Maine $163.62 $869.26

What the Data Says About Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope

Across 51 states with reporting providers, CPT code 43244 (Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope) shows a national average Medicare payment of $206.55 against an average billed charge of $1,115.82. That gap — a 5.4x markup, or 440% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Digestive Surgery procedures like this one saw 18.4K services billed to Medicare in 2023 by 6.6K distinct providers, serving 12.0K unique beneficiaries. State-level variation is significant: Maine reports the lowest average payment at $163.62, while Wyoming reports the highest at $336.36. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Digestive Surgery category (2.24x), the estimated commercial insurance price lands near $595.01, with self-pay cash discounts commonly bringing the figure closer to $506.07. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope cost?

The national average Medicare payment for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope (CPT 43244) is $206.55, while providers typically bill $1,115.82. Prices vary significantly by state, ranging from $163.62 to $336.36.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope cost with insurance?

With commercial insurance, Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope costs an estimated $595.01 on average (range: $416.51 – $833.01). Without insurance, the estimated cash price is $506.07. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope?

Maine has the lowest average Medicare payment for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope at $163.62, while Wyoming has the highest at $336.36. This $172.73 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope?

Nationally, 6.6K providers billed Medicare for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope in 2023, performing 18.4K total services for 12.0K beneficiaries across 51 states and territories.

What is the billed-to-Medicare markup for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope?

Providers bill 5.4x what Medicare pays for Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope — a 440% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial