45300

Diagnostic exam of rectum and lower large bowel using an endoscope

Medicare pricing data for 776 providers across 45 states

🤖AI Overview

Prices vary significantly by location — from $27 in Mississippi to $151 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

Diagnostic exam of rectum and lower large bowel using an endoscope (HCPCS code 45300) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $131.62, but hospitals typically charge $376.04 — a 2.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$26.32

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $131.62, your out-of-pocket cost would be approximately $26.32. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$131.62
Average Hospital Charge
$376.04
Markup Ratio
2.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$376.04
Medicare Allowed$131.62
Medicare Payment$98.83

Hospitals charge 2.9x more than what Medicare allows for this procedure. Medicare actually pays $98.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$151$692443+14.5%
Maryland$150$28820466+13.7%
New Jersey$145$45732654+10.4%
District of Columbia$144$303342+9.0%
Washington$143$38418233+8.6%
Connecticut$141$4471370+7.3%
California$141$294791,925+6.9%
New York$139$638921,897+5.7%
Massachusetts$138$5821497+4.5%
Colorado$133$335964+1.3%
Virginia$131$41324152-0.4%
Delaware$130$150126-1.2%
Minnesota$128$4891436-3.0%
Texas$127$333801,168-3.5%
Pennsylvania$127$23450742-3.6%
Nevada$126$222398-4.2%
Oregon$126$43518180-4.3%
Illinois$124$3571434-5.5%
Florida$123$31741323-6.4%
Indiana$123$2971451-6.5%
Puerto Rico$122$217858-7.5%
Missouri$122$28210180-7.5%
Utah$121$307518-7.9%
Arizona$121$19217271-7.9%
Iowa$119$32311123-9.2%
South Carolina$119$28815159-9.4%
Georgia$119$35523136-9.9%
North Carolina$118$66217179-10.5%
Ohio$118$23326262-10.6%
Kansas$117$2556217-11.1%
Nebraska$117$3419216-11.3%
Kentucky$116$15210290-11.8%
Alabama$116$2301054-11.8%
Oklahoma$116$219524-12.0%
Michigan$115$290831-13.0%
Arkansas$111$236349-15.3%
Tennessee$111$39818297-15.4%
Louisiana$109$204528-17.4%
West Virginia$100$394327-24.3%
New Hampshire$98$342219-25.9%
Wisconsin$96$4951026-26.8%
Idaho$91$284319-31.2%
Maine$38$301814-71.0%
Montana$32$197521-75.6%
Mississippi$27$2141127-79.7%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber