45381

Injection beneath lining of large bowel using a flexible endoscope

Medicare pricing data for 16,112 providers across 52 states

🤖AI Overview

This procedure has a 14.8x markup — hospitals charge $1,588 but Medicare allows only $107.10. Uninsured patients may face bills 14.8 times higher than what insurance negotiates. Prices vary significantly by location — from $20 in Maine to $154 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

Injection beneath lining of large bowel using a flexible endoscope (HCPCS code 45381) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $107.10, but hospitals typically charge $1,588 — a 14.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$21.42

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $107.10, your out-of-pocket cost would be approximately $21.42. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$107.10
Average Hospital Charge
$1,588
Markup Ratio
14.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,587.95
Medicare Allowed$107.10
Medicare Payment$88.00

Hospitals charge 14.8x more than what Medicare allows for this procedure. Medicare actually pays $88.00 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$154$2,96659274+43.6%
Hawaii$151$1,70953423+41.4%
California$151$1,9461,40510,630+41.3%
Nevada$150$2,01996614+40.1%
Maryland$141$1,1443342,837+31.9%
New Jersey$136$2,4035853,190+26.6%
Colorado$123$2,0432581,762+15.1%
Florida$123$1,5761,1076,369+14.8%
New York$120$2,0521,1345,212+12.4%
Arizona$120$1,6933372,376+12.1%
Rhode Island$120$1,42757220+12.0%
Delaware$118$1,27167464+10.4%
Puerto Rico$118$6042228+10.3%
Georgia$113$1,2784572,145+5.5%
Texas$109$2,1381,1686,537+1.9%
North Carolina$108$1,2165032,266+0.7%
Wyoming$106$2,03027133-0.7%
Louisiana$105$1,0982031,210-2.1%
Kansas$105$1,522136998-2.4%
Mississippi$103$1,4341251,268-3.5%
Oregon$103$1,405189703-4.2%
Connecticut$101$1,625219727-5.7%
Nebraska$99$1,283113556-7.2%
Washington$98$1,0243762,100-8.7%
Arkansas$95$968132646-11.5%
Utah$95$1,76395375-11.7%
Indiana$92$1,5483531,764-13.8%
Pennsylvania$91$1,1158263,535-14.7%
South Carolina$90$1,2052591,358-15.5%
Tennessee$89$1,2753141,362-16.7%
Alabama$87$1,198209952-18.7%
Michigan$86$9505001,768-19.7%
Ohio$84$1,1297212,691-21.3%
Iowa$83$1,266145695-22.7%
Massachusetts$81$1,2524151,533-24.8%
New Mexico$78$1,16871432-27.5%
Missouri$76$1,3363441,702-29.3%
Virginia$74$1,2914142,170-30.5%
Montana$74$1,02439421-30.7%
New Hampshire$73$2,45381471-31.9%
Oklahoma$71$921149833-33.7%
Illinois$68$1,5887144,151-36.3%
Idaho$67$67075514-37.4%
South Dakota$67$1,29751365-37.4%
Minnesota$66$1,2823501,391-38.1%
Wisconsin$58$2,8913101,146-45.7%
Kentucky$55$9232321,043-48.5%
Vermont$54$1,4632794-50.0%
District of Columbia$48$1,03540112-55.6%
North Dakota$45$1,19049197-57.7%
West Virginia$29$94763254-72.6%
Maine$20$79059211-81.3%

⚠️ 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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