Biopsy of lower large bowel using a flexible endoscope
Medicare pricing data for 12,610 providers across 52 states
This procedure has a 6.1x markup — hospitals charge $885.52 but Medicare allows only $144.24. Uninsured patients may face bills 6.1 times higher than what insurance negotiates. Prices vary significantly by location — from $69 in West Virginia to $225 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 lower large bowel using a flexible endoscope (HCPCS code 45331) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $144.24, but hospitals typically charge $885.52 — a 6.1x 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 $144.24, your out-of-pocket cost would be approximately $28.85. 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 6.1x more than what Medicare allows for this procedure. Medicare actually pays $112.61 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $225 | $1,832 | 40 | 139 | +56.2% |
| Wyoming | $199 | $1,008 | 20 | 47 | +38.3% |
| Puerto Rico | $186 | $276 | 37 | 40 | +28.8% |
| Nevada | $184 | $1,180 | 72 | 240 | +27.5% |
| New York | $181 | $1,234 | 884 | 2,398 | +25.4% |
| New Jersey | $178 | $1,461 | 449 | 1,383 | +23.2% |
| Maryland | $177 | $726 | 293 | 1,133 | +23.0% |
| Hawaii | $176 | $1,230 | 20 | 38 | +21.8% |
| California | $175 | $1,098 | 1,113 | 3,161 | +21.6% |
| Colorado | $169 | $2,448 | 190 | 479 | +16.8% |
| New Mexico | $165 | $796 | 57 | 199 | +14.3% |
| Tennessee | $164 | $866 | 245 | 1,142 | +13.6% |
| Arizona | $163 | $836 | 264 | 998 | +13.0% |
| Mississippi | $160 | $954 | 110 | 566 | +10.7% |
| Florida | $159 | $892 | 939 | 3,370 | +10.3% |
| Rhode Island | $152 | $704 | 44 | 105 | +5.4% |
| Louisiana | $149 | $612 | 162 | 682 | +3.4% |
| Delaware | $149 | $568 | 42 | 130 | +3.0% |
| Oregon | $148 | $959 | 159 | 360 | +2.6% |
| North Carolina | $145 | $655 | 457 | 1,364 | +0.8% |
| Arkansas | $142 | $542 | 101 | 403 | -1.5% |
| Iowa | $141 | $971 | 100 | 308 | -2.0% |
| Georgia | $140 | $759 | 338 | 850 | -3.0% |
| South Carolina | $139 | $638 | 196 | 742 | -3.7% |
| Pennsylvania | $137 | $604 | 686 | 1,727 | -4.7% |
| Texas | $136 | $1,167 | 799 | 2,074 | -5.8% |
| Idaho | $134 | $477 | 55 | 144 | -7.0% |
| Washington | $134 | $609 | 303 | 764 | -7.2% |
| Alabama | $127 | $700 | 182 | 645 | -11.7% |
| Ohio | $122 | $564 | 507 | 1,294 | -15.3% |
| Minnesota | $122 | $779 | 283 | 791 | -15.3% |
| Connecticut | $122 | $851 | 153 | 367 | -15.4% |
| Virginia | $122 | $640 | 338 | 787 | -15.6% |
| Indiana | $121 | $981 | 225 | 619 | -16.2% |
| Illinois | $118 | $871 | 521 | 1,499 | -18.5% |
| Kansas | $114 | $842 | 97 | 299 | -21.0% |
| Nebraska | $114 | $755 | 92 | 271 | -21.0% |
| New Hampshire | $113 | $999 | 71 | 189 | -21.4% |
| Utah | $111 | $544 | 68 | 147 | -23.0% |
| South Dakota | $106 | $759 | 31 | 86 | -26.3% |
| Michigan | $106 | $496 | 401 | 866 | -26.4% |
| Missouri | $103 | $695 | 260 | 667 | -28.7% |
| Massachusetts | $102 | $680 | 422 | 1,226 | -29.4% |
| Maine | $100 | $527 | 52 | 110 | -30.7% |
| District of Columbia | $98 | $433 | 36 | 109 | -31.8% |
| Kentucky | $96 | $536 | 153 | 390 | -33.1% |
| Wisconsin | $92 | $1,244 | 224 | 455 | -36.1% |
| Oklahoma | $88 | $473 | 102 | 246 | -39.2% |
| Montana | $85 | $452 | 33 | 85 | -41.0% |
| Vermont | $81 | $804 | 27 | 74 | -44.0% |
| North Dakota | $72 | $629 | 24 | 67 | -49.9% |
| West Virginia | $69 | $363 | 58 | 145 | -51.9% |
⚠️ 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