45384

Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery

Medicare pricing data for 3,545 providers across 50 states

🤖AI Overview

This procedure has a 6.9x markup — hospitals charge $1,815 but Medicare allows only $261.47. Uninsured patients may face bills 6.9 times higher than what insurance negotiates. Prices vary significantly by location — from $143 in New Mexico to $491 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

Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery (HCPCS code 45384) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $261.47, but hospitals typically charge $1,815 — a 6.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$52.29

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $261.47, your out-of-pocket cost would be approximately $52.29. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$261.47
Average Hospital Charge
$1,815
Markup Ratio
6.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,815.07
Medicare Allowed$261.47
Medicare Payment$211.78

Hospitals charge 6.9x more than what Medicare allows for this procedure. Medicare actually pays $211.78 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$491$555636+87.7%
New York$383$2,5722142,469+46.4%
Alaska$333$3,17117132+27.2%
Connecticut$320$1,23912121+22.5%
Illinois$316$2,8481162,429+20.8%
New Jersey$315$2,4011322,460+20.5%
California$309$2,4342345,093+18.1%
Maryland$285$1,622692,059+9.0%
Massachusetts$282$1,61534237+7.8%
Georgia$273$1,2961512,846+4.2%
Nevada$272$2,89529134+4.1%
Hawaii$268$1,83013637+2.7%
Arkansas$263$1,022551,974+0.5%
Florida$262$1,8143185,695+0.1%
Texas$258$2,8972634,158-1.5%
West Virginia$256$80325274-2.0%
Virginia$251$1,380901,438-4.0%
Mississippi$248$1,58647955-5.3%
Washington$245$1,57129199-6.2%
Oklahoma$241$90148775-8.0%
Pennsylvania$240$1,2931491,307-8.4%
Kansas$238$1,335701,249-9.1%
Louisiana$233$1,384891,888-10.8%
South Dakota$233$71020754-10.9%
Michigan$233$1,2201001,366-10.9%
Alabama$232$1,1801171,905-11.5%
Minnesota$231$1,62837448-11.8%
Wyoming$230$2,0371018-11.9%
Delaware$228$1,53411120-13.0%
Arizona$227$1,60744170-13.0%
Utah$227$1,0671130-13.2%
Tennessee$227$1,2671011,755-13.3%
Ohio$227$1,1961281,985-13.3%
South Carolina$226$1,445921,082-13.7%
Rhode Island$211$1,369517-19.3%
Idaho$210$1,1181566-19.8%
North Carolina$208$1,333102933-20.4%
Colorado$204$1,19333141-22.0%
Indiana$198$1,78598886-24.3%
Wisconsin$195$3,435761,189-25.4%
Kentucky$194$80453650-25.7%
Vermont$194$1,055417-25.8%
Iowa$186$1,20041282-29.0%
Missouri$175$1,38878939-32.9%
Oregon$170$1,41925202-35.0%
North Dakota$170$1,2241231-35.1%
Nebraska$165$1,19234380-37.0%
New Hampshire$156$91416230-40.2%
Maine$143$8261122-45.1%
New Mexico$143$1,36115100-45.3%

⚠️ 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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