45388

Destruction of polyp or growth of large bowel using a flexible endoscope

Medicare pricing data for 4,890 providers across 49 states

🤖AI Overview

This procedure has a 5.6x markup — hospitals charge $2,474 but Medicare allows only $438.28. Uninsured patients may face bills 5.6 times higher than what insurance negotiates. Prices vary significantly by location — from $241 in West Virginia to $1,559 in New York. 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

Destruction of polyp or growth of large bowel using a flexible endoscope (HCPCS code 45388) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $438.28, but hospitals typically charge $2,474 — a 5.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$87.66

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $438.28, your out-of-pocket cost would be approximately $87.66. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$438.28
Average Hospital Charge
$2,474
Markup Ratio
5.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,474.21
Medicare Allowed$438.28
Medicare Payment$354.90

Hospitals charge 5.6x more than what Medicare allows for this procedure. Medicare actually pays $354.90 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$1,559$5,0112721,208+255.7%
Idaho$1,208$1,8252282+175.6%
Nevada$920$3,7982068+109.8%
Arizona$727$1,86989761+65.9%
Arkansas$473$1,830671,265+7.9%
Virginia$470$3,130128426+7.2%
Michigan$427$1,885146892-2.6%
Massachusetts$422$2,197112198-3.6%
California$417$3,3113852,442-4.8%
New Jersey$417$4,996154575-4.8%
Hawaii$406$1,90818115-7.4%
Florida$393$2,2903882,067-10.3%
Delaware$383$1,53619111-12.6%
Wyoming$371$2,4481228-15.3%
North Carolina$361$2,730169553-17.6%
Texas$357$2,8373461,054-18.5%
Maryland$353$1,99990823-19.4%
Oregon$340$1,68964482-22.5%
Iowa$326$2,02434188-25.5%
Tennessee$326$1,690109558-25.7%
North Dakota$325$1,0771685-25.8%
Colorado$319$2,16254145-27.1%
Louisiana$318$1,82988523-27.4%
Pennsylvania$317$1,453252634-27.6%
Kansas$315$1,53840122-28.2%
Alabama$311$1,4751122,171-28.9%
South Carolina$307$2,04689375-30.0%
Washington$304$1,811126418-30.7%
Mississippi$303$3,55050225-30.9%
Missouri$300$2,312116460-31.5%
Georgia$300$2,247153328-31.6%
Minnesota$298$2,02173136-31.9%
Illinois$297$3,797212577-32.3%
Indiana$294$4,143117371-33.0%
District of Columbia$293$1,4981260-33.0%
Kentucky$290$1,40790459-33.8%
Rhode Island$285$2,4871325-34.9%
Montana$279$2,0071429-36.3%
Ohio$278$1,859222613-36.6%
Connecticut$273$2,5873958-37.8%
New Hampshire$272$1,38837397-37.9%
New Mexico$270$1,13418111-38.3%
Wisconsin$269$4,05399248-38.6%
Nebraska$266$4,9903556-39.2%
Oklahoma$263$1,31838129-39.9%
Maine$262$1,1532271-40.2%
Utah$254$2,2552139-42.0%
South Dakota$251$1,7601463-42.8%
West Virginia$241$1,5121137-45.0%

⚠️ 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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