Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope in California

California Pricing in Context

In California, CPT code 43255 (Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscope) carries an average Medicare payment of $185.38 - 13% above the national benchmark of $164.59. 1.0K providers across the state submitted claims for this procedure in 2023, performing 5.1K total services. Payment ranges by individual claim are not published in this CMS extract; the state average above is the figure to compare against the national benchmark.

The average billed charge in California is $1,508.65, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount, the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because California sits above the national Medicare average, commercial rates in the state may also run higher than the US median.

Using RAND 2024 commercial-to-Medicare ratios for Digestive Surgery procedures, the estimated commercial insurance price in California lands near $561.09, with self-pay cash prices typically around $590.22. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.