Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope
Price Range Across States
What You Might Pay
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 |
|---|---|---|
| Idaho | $298.31 | $1,476.63 |
| Kansas | $246.92 | $2,090.78 |
| Indiana | $236.42 | $1,646.31 |
| California | $232.74 | $1,161.03 |
| New York | $228.22 | $1,406.15 |
| Utah | $227.82 | $984.86 |
| Colorado | $226.87 | $1,313.65 |
| New Jersey | $226.23 | $1,403.80 |
| Maryland | $225.83 | $887.20 |
| Washington | $224.07 | $849.52 |
| Massachusetts | $221.06 | $1,104.59 |
| Louisiana | $219.68 | $1,006.68 |
| Connecticut | $217.58 | $1,559.38 |
| Georgia | $217.31 | $1,093.76 |
| Florida | $217.22 | $1,137.78 |
| Wisconsin | $215.17 | $2,121.74 |
| Mississippi | $214.53 | $1,066.55 |
| Illinois | $212.76 | $1,228.00 |
| Michigan | $209.79 | $865.99 |
| Oregon | $208.24 | $881.71 |
| Pennsylvania | $208.19 | $984.09 |
| Texas | $207.71 | $1,238.14 |
| South Dakota | $202.17 | $905.99 |
| District of Columbia | $201.87 | $877.30 |
| Nebraska | $201.58 | $960.49 |
| Nevada | $201.43 | $791.71 |
| Oklahoma | $200.49 | $1,274.81 |
| Virginia | $198.97 | $842.16 |
| Arizona | $198.83 | $1,003.36 |
| North Dakota | $198.27 | $769.40 |
| North Carolina | $197.27 | $903.45 |
| Minnesota | $196.48 | $1,451.29 |
| Ohio | $196.25 | $1,075.91 |
| New Hampshire | $195.45 | $4,567.39 |
| Missouri | $195.44 | $907.56 |
| South Carolina | $194.59 | $1,382.21 |
| West Virginia | $193.82 | $902.04 |
| Maine | $192.90 | $786.58 |
| Rhode Island | $192.87 | $936.38 |
| Alabama | $189.82 | $1,074.33 |
| Kentucky | $188.76 | $803.61 |
| New Mexico | $183.34 | $711.22 |
| Tennessee | $183.21 | $1,004.37 |
| Iowa | $180.85 | $1,067.99 |
| Arkansas | $178.95 | $2,152.51 |
| Vermont | $177.71 | $1,421.17 |
What the Data Says About Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope
Across 46 states with reporting providers, CPT code 43254 (Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope) shows a national average Medicare payment of $212.87 against an average billed charge of $1,174.91. That gap — a 5.5x markup, or 452% 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 6.2K services billed to Medicare in 2023 by 1.8K distinct providers, serving 5.6K unique beneficiaries. State-level variation is significant: Vermont reports the lowest average payment at $177.71, while Idaho reports the highest at $298.31. 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 $612.12, with self-pay cash discounts commonly bringing the figure closer to $528.05. 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 Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope cost?
The national average Medicare payment for Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope (CPT 43254) is $212.87, while providers typically bill $1,174.91. Prices vary significantly by state, ranging from $177.71 to $298.31.
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 Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope cost with insurance?
With commercial insurance, Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope costs an estimated $612.12 on average (range: $428.48 – $856.96). Without insurance, the estimated cash price is $528.05. 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 Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Vermont has the lowest average Medicare payment for Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope at $177.71, while Idaho has the highest at $298.31. This $120.60 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.
How many providers perform Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Nationally, 1.8K providers billed Medicare for Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope in 2023, performing 6.2K total services for 5.6K beneficiaries across 46 states and territories.
What is the billed-to-Medicare markup for Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Providers bill 5.5x what Medicare pays for Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope — a 452% 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 Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.