31653

Exam of lung airways and sampling of lymph nodes using an endoscope and ultrasound guidance, 3 or more lymph nodes

Medicare pricing data for 2,696 providers across 50 states

🤖AI Overview

This procedure has a 8.6x markup — hospitals charge $1,981 but Medicare allows only $230.59. Uninsured patients may face bills 8.6 times higher than what insurance negotiates. Prices vary significantly by location — from $195 in Tennessee to $601 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

Exam of lung airways and sampling of lymph nodes using an endoscope and ultrasound guidance, 3 or more lymph nodes (HCPCS code 31653) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $230.59, but hospitals typically charge $1,981 — a 8.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$46.12

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $230.59, your out-of-pocket cost would be approximately $46.12. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$230.59
Average Hospital Charge
$1,981
Markup Ratio
8.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,981.22
Medicare Allowed$230.59
Medicare Payment$182.39

Hospitals charge 8.6x more than what Medicare allows for this procedure. Medicare actually pays $182.39 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$601$6,774718+160.7%
District of Columbia$258$1,09312319+11.8%
Missouri$253$1,56081474+9.6%
New York$251$2,971140735+8.9%
Wisconsin$250$2,91063428+8.3%
Connecticut$247$2,45335308+7.1%
New Jersey$245$2,84144261+6.4%
Rhode Island$240$1,948550+4.3%
Maryland$240$2,33733739+4.1%
Oregon$236$3,14935103+2.4%
Florida$236$1,5611681,249+2.3%
Illinois$235$2,548109740+1.8%
Delaware$233$1,30912107+1.0%
West Virginia$233$9622646+1.0%
Virginia$232$1,83584372+0.6%
New Mexico$231$2,4511150+0.2%
California$231$2,7321631,495+0.1%
Montana$230$1,2621071-0.0%
Kentucky$230$1,04863322-0.2%
Michigan$230$948111625-0.2%
Pennsylvania$229$1,4231571,008-0.8%
South Dakota$228$8931248-1.0%
Colorado$228$1,03945269-1.1%
Texas$228$3,024154876-1.1%
Maine$227$6261575-1.3%
Utah$226$1,2041479-1.9%
Vermont$226$6,333755-1.9%
Ohio$226$1,543135802-1.9%
Alabama$226$1,33923158-2.0%
Massachusetts$225$1,71782687-2.3%
Louisiana$225$1,39638215-2.3%
New Hampshire$225$4,05416104-2.5%
Georgia$224$2,04085445-3.0%
North Carolina$223$2,48875377-3.1%
South Carolina$223$1,56650293-3.3%
Arizona$223$97445573-3.5%
Oklahoma$222$1,2782893-3.5%
Nevada$222$1,8401664-3.8%
Arkansas$222$1,79535176-3.9%
Idaho$221$594961-4.0%
Mississippi$220$1,46532194-4.4%
Indiana$220$2,05985475-4.7%
Nebraska$219$2,05629208-4.8%
Washington$217$1,54956364-5.8%
Kansas$217$1,02028139-5.8%
North Dakota$212$9861040-7.9%
Hawaii$207$774735-10.2%
Minnesota$203$2,99551393-11.9%
Iowa$195$2,38734169-15.2%
Tennessee$195$1,57888838-15.4%

⚠️ 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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