Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope
Medicare pricing data for 1,744 providers across 50 states
This procedure has a 5.1x markup — hospitals charge $1,293 but Medicare allows only $252.64. Uninsured patients may face bills 5.1 times higher than what insurance negotiates. Prices vary significantly by location — from $200 in Idaho to $481 in Wyoming. Where you get this procedure matters more than almost any other factor. 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
Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS code 43242) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $252.64, but hospitals typically charge $1,293 — a 5.1x 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 $252.64, your out-of-pocket cost would be approximately $50.53. 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 5.1x more than what Medicare allows for this procedure. Medicare actually pays $198.57 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Wyoming | $481 | $2,272 | 3 | 32 | +90.6% |
| Hawaii | $377 | $2,208 | 5 | 59 | +49.2% |
| Indiana | $317 | $2,334 | 34 | 618 | +25.6% |
| Alaska | $305 | $1,924 | 3 | 31 | +20.6% |
| Florida | $287 | $1,108 | 147 | 2,319 | +13.4% |
| New Jersey | $285 | $1,847 | 58 | 585 | +12.8% |
| New York | $282 | $1,713 | 130 | 1,342 | +11.8% |
| Arizona | $276 | $1,027 | 37 | 389 | +9.1% |
| Alabama | $271 | $1,261 | 24 | 310 | +7.4% |
| District of Columbia | $269 | $728 | 11 | 172 | +6.3% |
| Louisiana | $265 | $1,073 | 22 | 363 | +4.8% |
| Texas | $264 | $1,235 | 161 | 1,664 | +4.3% |
| Rhode Island | $260 | $1,284 | 5 | 45 | +2.8% |
| Maryland | $256 | $1,049 | 31 | 663 | +1.4% |
| Connecticut | $256 | $1,656 | 22 | 310 | +1.3% |
| California | $252 | $1,387 | 166 | 2,843 | -0.3% |
| Illinois | $251 | $1,366 | 63 | 1,001 | -0.6% |
| Kansas | $250 | $817 | 14 | 279 | -1.0% |
| Massachusetts | $248 | $1,249 | 43 | 1,009 | -1.8% |
| Georgia | $248 | $1,116 | 40 | 471 | -2.0% |
| Puerto Rico | $247 | $260 | 3 | 15 | -2.2% |
| Michigan | $246 | $923 | 63 | 720 | -2.6% |
| Montana | $245 | $774 | 7 | 122 | -2.9% |
| Colorado | $243 | $1,341 | 23 | 269 | -3.7% |
| Delaware | $239 | $644 | 6 | 116 | -5.4% |
| Pennsylvania | $238 | $1,080 | 78 | 1,277 | -6.0% |
| Kentucky | $237 | $977 | 23 | 271 | -6.0% |
| Tennessee | $237 | $1,303 | 21 | 511 | -6.0% |
| Minnesota | $236 | $1,254 | 38 | 603 | -6.6% |
| Ohio | $236 | $1,015 | 63 | 739 | -6.6% |
| Virginia | $235 | $1,010 | 57 | 622 | -6.9% |
| New Hampshire | $235 | $5,177 | 9 | 162 | -7.1% |
| Maine | $234 | $1,205 | 8 | 107 | -7.4% |
| Nevada | $233 | $777 | 7 | 227 | -7.8% |
| Utah | $232 | $1,007 | 5 | 52 | -8.3% |
| New Mexico | $231 | $1,104 | 7 | 81 | -8.5% |
| Washington | $231 | $968 | 37 | 568 | -8.6% |
| Missouri | $229 | $1,096 | 48 | 892 | -9.2% |
| Oregon | $227 | $1,046 | 29 | 235 | -10.0% |
| Mississippi | $226 | $966 | 6 | 121 | -10.4% |
| North Dakota | $223 | $1,007 | 4 | 33 | -11.7% |
| South Carolina | $223 | $1,295 | 24 | 562 | -11.7% |
| North Carolina | $222 | $1,076 | 41 | 940 | -12.1% |
| West Virginia | $221 | $1,135 | 13 | 215 | -12.6% |
| Oklahoma | $218 | $861 | 13 | 165 | -13.6% |
| Wisconsin | $216 | $2,744 | 35 | 342 | -14.4% |
| Iowa | $214 | $1,921 | 11 | 151 | -15.4% |
| Arkansas | $213 | $1,835 | 6 | 191 | -15.5% |
| Nebraska | $208 | $1,024 | 9 | 206 | -17.5% |
| Idaho | $200 | $855 | 3 | 60 | -20.9% |
⚠️ 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