45330

Diagnostic exam of lower portion of large bowel using a flexible endoscope

Medicare pricing data for 14,308 providers across 52 states

🤖AI Overview

This procedure has a 8.6x markup — hospitals charge $659.20 but Medicare allows only $76.33. Uninsured patients may face bills 8.6 times higher than what insurance negotiates. Prices vary significantly by location — from $46 in North Dakota to $137 in Puerto Rico. 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

Diagnostic exam of lower portion of large bowel using a flexible endoscope (HCPCS code 45330) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $76.33, but hospitals typically charge $659.20 — a 8.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$15.27

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $76.33, your out-of-pocket cost would be approximately $15.27. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$76.33
Average Hospital Charge
$659.20
Markup Ratio
8.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$659.20
Medicare Allowed$76.33
Medicare Payment$57.66

Hospitals charge 8.6x more than what Medicare allows for this procedure. Medicare actually pays $57.66 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$137$30349118+79.0%
New Jersey$101$1,0024811,717+32.3%
New York$100$8689823,589+30.9%
Rhode Island$91$53154143+19.5%
Pennsylvania$90$4858042,999+18.3%
California$90$8501,1793,808+18.1%
Virginia$87$5063781,256+14.0%
Maryland$84$6113251,415+9.9%
Hawaii$84$1,2892266+9.6%
Oklahoma$83$356132451+8.8%
Nevada$83$838102423+8.1%
Alaska$82$1,04844129+7.3%
Arizona$80$7832891,029+4.7%
Kansas$79$547126441+3.8%
Massachusetts$76$5294251,554+0.2%
Florida$76$6841,0813,822-0.1%
Colorado$75$1,762195479-2.2%
North Carolina$74$5384961,417-2.7%
Connecticut$73$636195424-3.9%
Indiana$73$735299939-4.7%
Minnesota$72$623273721-6.0%
Washington$69$412286716-9.9%
Delaware$69$44065216-9.9%
Tennessee$68$6162821,251-10.3%
Wyoming$68$8362256-10.8%
Oregon$68$617170420-11.1%
Georgia$66$6354131,270-13.1%
Illinois$66$6675691,846-13.6%
Louisiana$66$407224910-13.8%
Mississippi$65$687114635-14.5%
New Hampshire$65$67485274-14.8%
Wisconsin$65$1,018282568-15.2%
Michigan$65$3714301,067-15.4%
New Mexico$64$61067174-15.5%
South Carolina$64$537257837-15.8%
Texas$63$8359462,758-17.3%
Missouri$63$516284835-18.0%
Nebraska$62$55979292-19.2%
Ohio$60$4246021,735-21.6%
Montana$60$45137114-21.8%
Alabama$59$498223803-22.2%
Arkansas$59$414140492-23.3%
Vermont$56$55632144-26.7%
Utah$55$36377162-27.9%
Idaho$53$33855138-30.0%
South Dakota$53$5193580-30.0%
Iowa$53$697106308-30.4%
District of Columbia$53$27361215-31.2%
Maine$51$33653126-33.2%
West Virginia$51$25888253-33.6%
Kentucky$50$335215566-34.1%
North Dakota$46$4153061-39.1%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber