00813

Anesthesia for procedure on small and large bowel using an endoscope

Medicare pricing data for 70,100 providers across 52 states

🤖AI Overview

This procedure has a 10.2x markup — hospitals charge $1,287 but Medicare allows only $126.65. Uninsured patients may face bills 10.2 times higher than what insurance negotiates. Prices vary significantly by location — from $94 in Alabama to $211 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

Anesthesia for procedure on small and large bowel using an endoscope (HCPCS code 00813) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $126.65, but hospitals typically charge $1,287 — a 10.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$25.33

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $126.65, your out-of-pocket cost would be approximately $25.33. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$126.65
Average Hospital Charge
$1,287
Markup Ratio
10.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,287.04
Medicare Allowed$126.65
Medicare Payment$97.62

Hospitals charge 10.2x more than what Medicare allows for this procedure. Medicare actually pays $97.62 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$211$1,273132797+66.7%
California$163$1,4364,29940,848+28.8%
Puerto Rico$156$1,88058970+23.2%
Montana$156$9771801,649+22.9%
Wyoming$153$1,299881,162+20.8%
New Mexico$151$1,2642762,373+19.3%
Hawaii$151$1,0261431,428+19.1%
Washington$151$1,1241,3068,373+18.9%
Idaho$150$8852031,326+18.4%
Oregon$149$1,0416033,215+18.0%
Utah$146$1,0084572,527+15.6%
Nevada$145$1,4043353,352+14.4%
New York$143$1,8613,89637,799+13.1%
Oklahoma$142$1,1826607,075+12.5%
Maryland$142$1,4791,18616,243+12.0%
Arkansas$141$9745354,777+11.7%
Iowa$141$1,0084923,361+11.6%
Nebraska$138$8785153,903+9.3%
Arizona$136$1,7051,14010,413+7.4%
Colorado$134$1,1961,0886,532+5.5%
Florida$133$1,4685,31957,250+5.1%
Indiana$131$1,1301,2319,603+3.8%
New Jersey$130$1,3811,72118,765+2.8%
Kentucky$130$1,0921,20811,655+2.7%
Illinois$130$1,4092,76028,623+2.7%
Louisiana$129$1,0171,0338,607+2.1%
Delaware$128$1,2582483,160+1.4%
Tennessee$126$1,2111,91116,039-0.5%
Kansas$126$8148487,758-0.5%
Texas$125$1,4845,60250,720-1.6%
Missouri$122$1,1171,73213,331-3.5%
Vermont$121$933110624-4.7%
District of Columbia$120$1,1033262,473-5.5%
Ohio$120$1,0433,15621,997-5.5%
North Dakota$119$1,3872851,982-6.3%
Mississippi$119$8495866,929-6.3%
New Hampshire$117$1,4674403,492-7.7%
Wisconsin$116$1,5551,5609,265-8.4%
Rhode Island$113$1,0911972,188-10.5%
Connecticut$113$1,25299910,068-11.0%
Massachusetts$111$9911,94419,057-12.1%
North Carolina$111$1,1162,54121,291-12.5%
Virginia$111$1,2601,81319,050-12.5%
Georgia$109$1,1632,46217,840-13.9%
South Carolina$109$1,1621,41315,744-14.3%
Minnesota$108$9751,3886,911-14.7%
Maine$107$1,0354662,772-15.2%
Pennsylvania$107$1,0324,15533,862-15.3%
West Virginia$105$1,1225024,215-17.1%
Michigan$103$1,2162,87919,101-18.6%
South Dakota$103$1,0693533,252-18.7%
Alabama$94$9721,27112,478-26.2%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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