Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 43260 Fee Schedule
Medicare rates as of October 2026
CPT 43260 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 53 - Discontinued procedure 52 - Reduced Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $280.90 national non-facility rate (2026) · View Medicare rates for 43260 |
| Medicaid Fee Schedule | $228.825 median of the 8 states in the free preview · View Medicaid rates for 43260 |
National average reimbursement for CPT 43260 by major payers:
$425.63
BCBS / Anthem
$447.73
UnitedHealthcare
$475.63
Aetna
$535.63
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43260.
CPT 43260
5 of 25 sample ratesHigher to lower in this preview
South Emerson Surgery Center, LLC
$7,688.00Published ratePrince Frederick Surgery Center LLC
Prince Frederick Surgery Center, LLC
$2,307.00Published rateSalmon Creek Plastic Surgery PC, Salmon Creek Plastic Surgery PC/Asc Facility
Salmon Creek Plastic Surgery, PC
$1,436.00Published rateMethodist Ambulatory Surgery Center Of Landmark, LLC
Methodist Ambulatory Surgery Center Of Landmark LLC
$830.00Published rateBrooklyn Endoscopy Sc, LLC, Gnyesc
Brooklyn Endoscopy Sc LLC
$432.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 43260 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43260. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 43260-CPT | Moderate | Endoscopic Retrograde Cholangiopancreatography (Ercp); Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Revised 01/01/2014) |
| 43263-CPT | Moderate | Scope Exam Of Bile Ducts, Examination Of The Bile Ducts And Pancreatic Ducts Using A Scope. The Procedure Includes Pressure Measurement Of A Sphincter (Band Of Muscle Around An Opening). |
| 43264-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Endoscopic Retrograde Removal Of Stone(S) From Biliary Andor Pancreatic Ducts |
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43260 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 43260) and we'll show you how you compare in 15 minutes or less.