45382

Control of bleeding of upper large bowel using a flexible endoscope

Medicare pricing data for 8,514 providers across 51 states

🤖AI Overview

This procedure has a 5.9x markup — hospitals charge $1,619 but Medicare allows only $273.33. Uninsured patients may face bills 5.9 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

Control of bleeding of upper large bowel using a flexible endoscope (HCPCS code 45382) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $273.33, but hospitals typically charge $1,619 — a 5.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$54.67

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $273.33, your out-of-pocket cost would be approximately $54.67. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$273.33
Average Hospital Charge
$1,619
Markup Ratio
5.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,619.29
Medicare Allowed$273.33
Medicare Payment$217.07

Hospitals charge 5.9x more than what Medicare allows for this procedure. Medicare actually pays $217.07 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$353$2,2956371,750+29.0%
Alaska$339$2,6422345+24.0%
California$294$1,8708102,766+7.6%
Florida$294$1,3596552,120+7.4%
Hawaii$291$1,7623092+6.5%
New Jersey$287$2,2603631,066+5.1%
Maryland$278$1,319205773+1.7%
Wyoming$278$1,9321527+1.6%
Oregon$277$1,73983162+1.4%
Massachusetts$275$1,643245550+0.8%
Connecticut$273$1,695108191+0.1%
Utah$270$1,9883890-1.3%
Virginia$268$1,348241593-2.0%
Rhode Island$267$1,32947100-2.4%
New Mexico$264$1,2462562-3.3%
Illinois$264$1,734322843-3.4%
Michigan$263$1,047229528-3.9%
Colorado$263$1,346127243-4.0%
Washington$262$1,421168403-4.2%
Mississippi$261$1,73968177-4.3%
Arizona$261$1,214155337-4.4%
District of Columbia$259$1,2292765-5.3%
Pennsylvania$258$1,205409889-5.5%
Louisiana$258$1,308113255-5.5%
Delaware$257$1,2103092-6.1%
Texas$255$1,6266191,634-6.6%
Nevada$255$1,18448143-6.9%
North Carolina$254$1,542275589-7.1%
Montana$253$1,3512373-7.4%
Ohio$253$1,199316696-7.5%
South Carolina$252$1,337140398-7.8%
North Dakota$251$1,4751989-8.0%
Georgia$251$1,486188382-8.2%
New Hampshire$250$2,83052107-8.6%
Kansas$249$1,36768180-8.8%
Oklahoma$248$1,03586188-9.3%
Indiana$247$1,318184497-9.8%
Maine$246$1,2363161-10.1%
Iowa$246$1,90367174-10.1%
Missouri$245$1,366190498-10.3%
Minnesota$245$1,848135274-10.4%
Arkansas$243$1,22970182-11.3%
Nebraska$242$1,68550294-11.4%
Wisconsin$242$3,189160316-11.5%
Kentucky$242$1,014128371-11.5%
Tennessee$242$1,555182585-11.6%
West Virginia$238$1,1123793-13.0%
Idaho$237$75943118-13.1%
Vermont$236$1,8741235-13.7%
South Dakota$234$1,7952548-14.3%
Alabama$224$1,708115546-18.1%

⚠️ 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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