Incision of pancreatic outlet using a flexible endoscope
Medicare pricing data for 4,084 providers across 51 states
This procedure has a 19.0x markup — hospitals charge $1,449 but Medicare allows only $76.18. Uninsured patients may face bills 19.0 times higher than what insurance negotiates. Prices vary significantly by location — from $57 in North Carolina to $144 in Alaska. 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
Incision of pancreatic outlet using a flexible endoscope (HCPCS code 43262) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $76.18, but hospitals typically charge $1,449 — a 19.0x 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 $76.18, your out-of-pocket cost would be approximately $15.24. 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 19.0x more than what Medicare allows for this procedure. Medicare actually pays $60.38 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $144 | $3,054 | 8 | 61 | +89.6% |
| New Hampshire | $101 | $5,037 | 19 | 146 | +32.6% |
| Vermont | $96 | $2,013 | 6 | 67 | +26.5% |
| Maine | $92 | $1,493 | 11 | 107 | +20.6% |
| Hawaii | $90 | $913 | 14 | 45 | +18.4% |
| New Jersey | $88 | $2,352 | 126 | 610 | +15.9% |
| Oregon | $88 | $1,290 | 62 | 281 | +15.5% |
| South Carolina | $87 | $1,631 | 65 | 340 | +14.1% |
| Delaware | $86 | $853 | 8 | 96 | +13.1% |
| Connecticut | $85 | $1,843 | 54 | 267 | +11.8% |
| Nebraska | $85 | $1,342 | 29 | 273 | +11.5% |
| Tennessee | $85 | $1,368 | 102 | 616 | +11.1% |
| District of Columbia | $84 | $1,167 | 11 | 51 | +9.8% |
| Georgia | $81 | $1,236 | 133 | 576 | +6.7% |
| Wyoming | $81 | $2,201 | 5 | 13 | +6.4% |
| Florida | $81 | $1,157 | 314 | 1,614 | +5.9% |
| Maryland | $81 | $1,266 | 61 | 453 | +5.8% |
| Arizona | $80 | $1,173 | 74 | 448 | +5.2% |
| Rhode Island | $80 | $1,369 | 17 | 98 | +5.0% |
| New York | $79 | $1,900 | 205 | 1,248 | +3.4% |
| California | $79 | $1,350 | 417 | 2,631 | +3.4% |
| Wisconsin | $79 | $3,253 | 90 | 483 | +3.2% |
| Illinois | $79 | $1,858 | 149 | 959 | +3.2% |
| Pennsylvania | $77 | $1,383 | 220 | 1,201 | +1.3% |
| Nevada | $76 | $1,086 | 26 | 256 | -0.3% |
| North Dakota | $75 | $1,337 | 9 | 66 | -1.4% |
| Missouri | $75 | $1,260 | 100 | 565 | -2.1% |
| Minnesota | $74 | $1,532 | 49 | 443 | -2.6% |
| Kentucky | $74 | $998 | 61 | 326 | -2.7% |
| Ohio | $74 | $1,309 | 121 | 710 | -2.9% |
| Michigan | $74 | $1,004 | 142 | 689 | -3.5% |
| Colorado | $73 | $1,246 | 82 | 305 | -3.9% |
| Massachusetts | $73 | $1,416 | 96 | 866 | -4.1% |
| Louisiana | $73 | $1,336 | 76 | 323 | -4.2% |
| Kansas | $73 | $1,159 | 29 | 219 | -4.4% |
| Mississippi | $73 | $1,468 | 36 | 202 | -4.7% |
| Indiana | $72 | $1,386 | 94 | 524 | -5.5% |
| Alabama | $72 | $1,329 | 43 | 240 | -6.1% |
| Montana | $71 | $1,152 | 16 | 112 | -6.3% |
| Virginia | $71 | $1,148 | 94 | 550 | -7.0% |
| Texas | $71 | $1,329 | 364 | 1,922 | -7.1% |
| New Mexico | $67 | $1,236 | 13 | 84 | -11.5% |
| Idaho | $67 | $861 | 34 | 171 | -11.6% |
| Utah | $66 | $1,099 | 26 | 137 | -12.8% |
| Washington | $66 | $1,025 | 80 | 543 | -13.5% |
| Oklahoma | $64 | $1,058 | 39 | 248 | -15.7% |
| South Dakota | $62 | $903 | 9 | 76 | -19.1% |
| Iowa | $61 | $1,846 | 27 | 209 | -19.4% |
| West Virginia | $61 | $1,250 | 22 | 164 | -19.4% |
| Arkansas | $61 | $1,504 | 36 | 278 | -19.6% |
| North Carolina | $57 | $1,486 | 121 | 702 | -25.5% |
⚠️ 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