31654

Exam of lung airways with diagnostic or therapeutic procedure on growths using an endoscope and ultrasound

Medicare pricing data for 1,824 providers across 48 states

🤖AI Overview

This procedure has a 5.3x markup — hospitals charge $347.32 but Medicare allows only $65.06. Uninsured patients may face bills 5.3 times higher than what insurance negotiates. 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 with diagnostic or therapeutic procedure on growths using an endoscope and ultrasound (HCPCS code 31654) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $65.06, but hospitals typically charge $347.32 — a 5.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$13.01

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $65.06, your out-of-pocket cost would be approximately $13.01. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$65.06
Average Hospital Charge
$347.32
Markup Ratio
5.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$347.32
Medicare Allowed$65.06
Medicare Payment$51.93

Hospitals charge 5.3x more than what Medicare allows for this procedure. Medicare actually pays $51.93 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$72$80591914+10.7%
District of Columbia$70$26211221+7.4%
California$69$3581061,308+5.3%
New Jersey$68$36436303+5.1%
Massachusetts$68$36351569+4.9%
Connecticut$68$46619261+4.8%
Hawaii$67$181676+3.3%
Illinois$67$403841,091+3.1%
Maryland$67$44029517+2.9%
Virginia$67$29539424+2.5%
Pennsylvania$66$3171061,163+1.1%
Montana$66$231561+1.0%
New Hampshire$66$1,158365+1.0%
Michigan$65$25557412+0.4%
Delaware$65$3027123+0.2%
Washington$65$23032413+0.0%
Nevada$65$29111132+0.0%
Florida$65$2741421,752-0.4%
New Mexico$65$299312-0.5%
West Virginia$65$2362072-0.8%
Arizona$65$31432567-0.8%
Texas$64$341108937-1.0%
Oregon$64$32718115-1.0%
Georgia$64$30853643-1.5%
Missouri$64$25350529-1.5%
Ohio$64$29494666-1.5%
Louisiana$64$35430335-1.5%
Colorado$64$25625275-1.8%
Vermont$64$509229-2.0%
Minnesota$64$37942346-2.4%
Utah$63$263662-2.8%
Oklahoma$63$24221218-2.9%
Kentucky$63$19060464-3.4%
South Dakota$63$398217-3.5%
North Dakota$63$430419-3.6%
Alabama$62$20523204-4.0%
North Carolina$62$36071859-4.2%
South Carolina$62$33824260-4.5%
Idaho$62$149970-4.8%
Indiana$62$34160764-4.8%
Kansas$62$25819156-5.1%
Tennessee$61$241681,136-5.6%
Iowa$61$27821169-5.9%
Mississippi$61$21623216-6.0%
Rhode Island$61$291413-6.7%
Wisconsin$60$68148480-7.3%
Nebraska$60$30319185-7.5%
Arkansas$60$27711106-8.1%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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