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See a sample rate comparisonCPT 43274 Fee Schedule
Medicare rates as of October 2026
CPT 43274 is classified under Surgery, in the Surgical Procedures on the Digestive System subgroup.
Ercp Duct Stent Placement, Endoscopic Retrograde Cholangiopancreatography Ercp With Placement Of Endoscopic Stent Into Biliary Or Pancreatic Duct Including Pre And Post Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent
| 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 | 59 - Distinct Procedural Service XS - Separate Structure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $402.15 national non-facility rate (2026) · View Medicare rates for 43274 |
| Medicaid Fee Schedule | $327.15 median of the 8 states in the free preview · View Medicaid rates for 43274 |
National average reimbursement for CPT 43274 by major payers:
$626.01
BCBS / Anthem
$651.61
UnitedHealthcare
$670.09
Aetna
$780.01
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 43274.
CPT 43274
5 of 25 sample ratesHigher to lower in this preview
Northwest Surgery Center, Ltd, Northwest Surgery Center Red Oak
Northwest Surgery Center Ltd
$5,841.00Published rateGeorgia Interventional Pain
$1,600.00Published rateFt Scott Surgery Center LLC
$1,418.00Published rateAdvanced Surgery Center Of Arizona, LLP, Advanced Surgery Center Of Arizona
$750.00Published ratePiedmont Endoscopy Center, Inc.
$369.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 43274 vs. Other Surgical Procedures on the Digestive System Codes
The table lists codes related to 43274. 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). |
| 43265-CPT | Moderate | Endoscopic Retrograde Cholangi, Endoscopic Retrograde Cholangiopancreatography (Ercp) With Destruction Of Calculi Any Method (Eg Mechanical Electrohydraulic Lithotripsy) |
| 43274-CPT | Moderate | Ercp Duct Stent Placement, Endoscopic Retrograde Cholangiopancreatography Ercp With Placement Of Endoscopic Stent Into Biliary Or Pancreatic Duct Including Pre And Post Dilation And Guide Wire Passage When Performed Including Sphincterotomy When Performed Each Stent |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43274. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43274 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.
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Frequently Asked Questions
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare professionals to report medical, surgical, and diagnostic procedures and services to entities like insurance companies. They are crucial for billing and tracking healthcare services.
The cost of a medical procedure can vary widely based on your insurance plan, location, the healthcare provider, and the specific services rendered. For accurate and specific pricing information based on CPT code and your location, it is recommended to use specialized tools like Payerprice.
To look up specific medical procedure prices based on a CPT code and your location, it is recommended to use a specialized fee schedule lookup tool. Payerprice offers such a tool that allows you to search with a CPT code and specific location to get relevant pricing information.
Medical procedure costs can vary significantly by location due to factors such as regional differences in labor costs, overhead for facilities, local market competition, and varying insurance contract rates. These factors contribute to the wide range of prices for the same service in different areas.
Payerprice is a service that provides a fee schedule lookup tool. It allows users to search for the cost of medical procedures using CPT codes and specific locations, helping them understand potential healthcare expenses.
Payerprice helps you find medical costs by providing a fee schedule lookup tool. You can input a specific CPT code and your location into the tool to search for pricing information related to medical procedures, allowing you to get a better estimate of potential expenses.