Biopsy of lobe of lung using an endoscope, 1 lobe
Medicare pricing data for 4,374 providers across 50 states
This procedure has a 10.2x markup — hospitals charge $984.95 but Medicare allows only $96.81. Uninsured patients may face bills 10.2 times higher than what insurance negotiates. Prices vary significantly by location — from $53 in District of Columbia to $326 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
Biopsy of lobe of lung using an endoscope, 1 lobe (HCPCS code 31628) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $96.81, but hospitals typically charge $984.95 — a 10.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $96.81, your out-of-pocket cost would be approximately $19.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 10.2x more than what Medicare allows for this procedure. Medicare actually pays $76.52 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $326 | $2,862 | 9 | 41 | +236.8% |
| South Dakota | $180 | $1,421 | 12 | 38 | +85.7% |
| Utah | $137 | $815 | 25 | 119 | +41.7% |
| Arkansas | $127 | $686 | 38 | 283 | +31.2% |
| New York | $119 | $1,945 | 212 | 1,725 | +22.7% |
| New Mexico | $118 | $898 | 16 | 43 | +21.9% |
| New Jersey | $116 | $1,081 | 104 | 567 | +19.9% |
| Maine | $115 | $503 | 11 | 35 | +19.0% |
| Colorado | $111 | $608 | 64 | 469 | +14.5% |
| Arizona | $109 | $580 | 105 | 1,225 | +13.1% |
| Vermont | $109 | $1,244 | 9 | 41 | +12.7% |
| Oklahoma | $105 | $678 | 53 | 329 | +8.3% |
| Texas | $104 | $934 | 358 | 2,545 | +7.9% |
| Wisconsin | $104 | $1,963 | 103 | 851 | +7.4% |
| California | $103 | $1,179 | 300 | 2,884 | +6.8% |
| West Virginia | $102 | $689 | 41 | 157 | +5.6% |
| Massachusetts | $102 | $995 | 102 | 904 | +5.5% |
| Illinois | $101 | $1,324 | 184 | 1,993 | +4.1% |
| Missouri | $100 | $831 | 122 | 772 | +3.5% |
| Pennsylvania | $99 | $794 | 211 | 1,864 | +2.0% |
| North Dakota | $96 | $1,289 | 12 | 41 | -0.3% |
| Oregon | $96 | $983 | 51 | 230 | -0.4% |
| Mississippi | $95 | $1,148 | 52 | 555 | -1.6% |
| Alabama | $95 | $822 | 70 | 472 | -1.9% |
| Minnesota | $95 | $1,164 | 75 | 562 | -2.1% |
| Michigan | $95 | $691 | 157 | 922 | -2.3% |
| Ohio | $94 | $807 | 172 | 1,384 | -2.6% |
| Kansas | $93 | $647 | 32 | 330 | -4.4% |
| Virginia | $93 | $792 | 123 | 854 | -4.4% |
| Kentucky | $92 | $632 | 106 | 727 | -4.8% |
| Florida | $92 | $730 | 340 | 2,919 | -5.2% |
| North Carolina | $90 | $966 | 149 | 1,374 | -7.5% |
| Washington | $89 | $605 | 96 | 601 | -8.0% |
| Iowa | $88 | $952 | 50 | 381 | -8.7% |
| Montana | $87 | $632 | 11 | 110 | -10.2% |
| Nebraska | $87 | $1,013 | 31 | 219 | -10.6% |
| Georgia | $86 | $954 | 139 | 1,174 | -11.5% |
| Maryland | $83 | $1,311 | 70 | 731 | -13.8% |
| Delaware | $82 | $733 | 10 | 252 | -15.1% |
| Louisiana | $82 | $808 | 63 | 496 | -15.6% |
| Rhode Island | $82 | $844 | 7 | 24 | -15.7% |
| South Carolina | $80 | $780 | 71 | 688 | -17.5% |
| New Hampshire | $79 | $3,012 | 14 | 75 | -18.1% |
| Indiana | $79 | $895 | 113 | 1,009 | -18.2% |
| Tennessee | $79 | $838 | 138 | 1,508 | -18.2% |
| Connecticut | $79 | $1,038 | 49 | 337 | -18.3% |
| Nevada | $74 | $919 | 24 | 190 | -23.1% |
| Idaho | $70 | $456 | 13 | 65 | -28.0% |
| Hawaii | $69 | $790 | 10 | 102 | -28.3% |
| District of Columbia | $53 | $735 | 16 | 296 | -45.1% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber