Digestive Surgery · 43255
Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope
What Medicare pays for 43255, what providers bill, and how the price varies across 51 states, drawn from CMS 2023 claims data.
- $164.59
- Medicare pays
- $1,239.83
- Providers bill
- 7.5×
- Markup
- #1,526 of 9,297
- Volume rank
The verdict
Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope pairs top-quartile national service volume with a higher-than-typical markup.
- Top 16%
- national service volume
- Top 25%
- billed-to-Medicare markup
- 7.5×
- billed vs. Medicare
- $164.59
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
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). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Digestive Surgery, the applied ratio is 2.54x Medicare (RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline). 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.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
8 Among the most affordable more affordable than 75% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$1,239.83
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Alaska | $219.82 | $2,008.27 |
| Hawaii | $188.58 | $1,086.61 |
| New York | $186.12 | $1,737.66 |
| Rhode Island | $185.69 | $1,152.28 |
| California | $185.38 | $1,508.65 |
| New Jersey | $182.52 | $1,819.10 |
| Maryland | $182.33 | $1,169.10 |
| Wyoming | $181.66 | $1,414.19 |
| Florida | $179.28 | $1,016.96 |
| Nebraska | $177.23 | $1,605.62 |
| Mississippi | $176.35 | $1,268.65 |
| Louisiana | $172.00 | $1,027.14 |
| Connecticut | $165.84 | $1,234.21 |
| Washington | $163.47 | $1,107.47 |
| Michigan | $162.11 | $823.81 |
| Texas | $161.93 | $1,210.68 |
| Alabama | $161.15 | $1,143.08 |
| Oregon | $161.12 | $1,613.41 |
| Illinois | $160.65 | $1,468.79 |
| Utah | $160.49 | $1,245.80 |
| Colorado | $159.22 | $954.04 |
| District of Columbia | $158.54 | $1,072.93 |
| Pennsylvania | $158.28 | $904.43 |
| Massachusetts | $157.82 | $1,050.81 |
| Maine | $157.64 | $959.55 |
| Iowa | $157.55 | $1,456.34 |
| Nevada | $157.17 | $840.52 |
| Georgia | $156.87 | $1,204.57 |
| South Carolina | $156.73 | $1,099.40 |
| Idaho | $155.47 | $626.03 |
| Arizona | $155.00 | $834.28 |
| Tennessee | $154.92 | $1,366.93 |
| Kansas | $153.98 | $1,103.02 |
| Ohio | $153.65 | $965.72 |
| Montana | $152.80 | $1,022.49 |
| New Hampshire | $152.74 | $2,358.17 |
| North Carolina | $151.47 | $1,247.97 |
| North Dakota | $151.46 | $1,314.69 |
| Delaware | $151.44 | $1,020.24 |
| Arkansas | $150.17 | $916.50 |
| Kentucky | $149.53 | $788.10 |
| Virginia | $149.53 | $1,035.10 |
| New Mexico | $149.07 | $907.25 |
| Oklahoma | $148.57 | $888.00 |
| South Dakota | $146.84 | $1,273.90 |
| Missouri | $146.76 | $1,049.51 |
| Minnesota | $146.75 | $1,347.03 |
| Wisconsin | $143.55 | $2,765.86 |
| Indiana | $143.45 | $1,072.71 |
| West Virginia | $139.40 | $868.21 |
| Vermont | $138.86 | $1,794.01 |
What the Data Says About Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope
Across 51 states with reporting providers, CPT code 43255 (Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope) shows a national average Medicare payment of $164.59 against an average billed charge of $1,239.83. That gap, a 7.5x markup, or 653% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.
Digestive Surgery procedures like this one saw 53.6K services billed to Medicare in 2023 by 11.8K distinct providers, serving 45.1K unique beneficiaries. State-level variation is significant: Vermont reports the lowest average payment at $138.86, while Alaska reports the highest at $219.82. A 58% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.54x Medicare; RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline), the estimated commercial insurance price lands near $528.80, with self-pay cash discounts commonly bringing the figure closer to $497.10. Within Digestive Surgery, Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope ranks #551 of 765 tracked procedures by national average Medicare payment.
Where this sits in the registry
Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope (43255) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Digestive Surgery codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope rank among Medicare procedures?
According to CMS Medicare Part B claims, Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope (CPT 43255) ranks #1,526 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #551 of 765 within Digestive Surgery by national average Medicare payment. See /methodology#corpus-placement.
How much does Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope cost?
Medicare's national average payment for Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope (CPT 43255) is $164.59, with providers billing $1,239.83 on average; state rates run from $138.86 to $219.82, a meaningful but not extreme spread.
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 Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope cost with insurance?
Commercial insurers pay well above Medicare for control of bleeding of esophagus, stomach, and/or upper small bowel using a flexible endoscope, an estimated $528.80 on average (range: $370.16-$740.33), versus $164.59 from Medicare. Without insurance, the estimated cash price is $497.10.
Which state has the lowest cost for Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Vermont has the lowest average Medicare payment for Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope at $138.86, while Alaska has the highest at $219.82 - a meaningful $80.96 spread.
How many providers perform Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope is a widely-performed procedure: 11.8K providers billed Medicare for it in 2023 across 51 states, together handling 53.6K services for 45.1K beneficiaries.
What is the billed-to-Medicare markup for Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope?
Providers bill 7.5x what Medicare pays for Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope - a higher-than-typical markup at 653% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (53.6K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($164.59 here).
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
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.