31629

Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope

Medicare pricing data for 2,597 providers across 49 states

🤖AI Overview

This procedure has a 8.5x markup — hospitals charge $1,244 but Medicare allows only $146.97. Uninsured patients may face bills 8.5 times higher than what insurance negotiates. Prices vary significantly by location — from $106 in Maine to $268 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

Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope (HCPCS code 31629) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $146.97, but hospitals typically charge $1,244 — a 8.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$29.39

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $146.97, your out-of-pocket cost would be approximately $29.39. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$146.97
Average Hospital Charge
$1,244
Markup Ratio
8.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,243.99
Medicare Allowed$146.97
Medicare Payment$116.66

Hospitals charge 8.5x more than what Medicare allows for this procedure. Medicare actually pays $116.66 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$268$3,890627+82.2%
South Dakota$244$1,679823+65.7%
West Virginia$164$71925106+11.8%
Virginia$162$1,22779632+10.2%
New York$160$2,669117986+8.7%
California$159$1,5531531,902+8.5%
Oregon$159$1,19425136+8.1%
Oklahoma$157$1,10328239+6.9%
Utah$157$9751247+6.9%
New Jersey$156$1,42142276+6.3%
North Carolina$154$1,3691061,039+4.9%
Kentucky$154$60561511+4.6%
Georgia$153$1,32291855+3.9%
New Hampshire$152$3,060968+3.7%
Nevada$152$1,29621179+3.6%
Iowa$151$1,09331257+2.6%
Louisiana$151$93336359+2.5%
Montana$150$8631068+2.3%
Connecticut$149$1,28933259+1.6%
Delaware$149$8949167+1.4%
Texas$149$1,3091931,550+1.4%
Kansas$149$68420200+1.3%
South Carolina$149$82242557+1.2%
Arizona$148$71255542+1.0%
Colorado$148$65533221+0.9%
Michigan$147$766103600+0.1%
Alabama$147$96833316-0.1%
Indiana$147$1,06885836-0.2%
Missouri$146$1,04262571-0.3%
Florida$146$8382152,013-0.4%
Pennsylvania$146$1,0621331,225-1.0%
Illinois$144$1,850961,122-1.8%
Massachusetts$143$1,32071578-2.5%
Washington$142$70846442-3.2%
Mississippi$142$1,43040324-3.5%
Nebraska$141$1,38625125-4.2%
Maryland$140$1,55239628-5.1%
Idaho$139$451986-5.5%
Arkansas$137$8882168-6.8%
Ohio$135$804128904-8.4%
District of Columbia$134$82810319-8.9%
Wisconsin$130$2,43654469-11.6%
Hawaii$123$9437126-16.5%
North Dakota$121$2,365948-17.8%
Vermont$120$1,653540-18.5%
Tennessee$119$1,114811,176-18.9%
Minnesota$118$1,24745393-19.7%
Rhode Island$112$712740-23.5%
Maine$106$458935-28.0%

⚠️ 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