45380

Biopsy of large bowel using a flexible endoscope

Code 45380. Medicare covered 1,287,849 of these. Here is what providers billed and what Medicare allowed, state by state.

$1,789.26Billed, national avg
$240.45Medicare allowed
7.4xBilled vs allowed
7.1xHighest vs lowest state

Providers in Alaska billed the most for this, at $3,311.30. In Puerto Rico the average was $466.09. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$3,311.30$294.4011.2x4,131
Wisconsin$2,932.33$168.4117.4x17,327
New Jersey$2,708.28$287.679.4x57,390
Nevada$2,582.48$312.918.3x11,660
New Hampshire$2,488.60$183.2813.6x7,114
Texas$2,451.21$244.8010.0x98,044
Virgin Islands$2,439.95$301.168.1x58
Utah$2,351.31$213.4911.0x8,512
California$2,324.87$288.378.1x154,814
Colorado$2,295.27$253.829.0x21,050
New York$2,282.26$280.218.1x82,035
Wyoming$1,942.11$254.307.6x3,182
Hawaii$1,867.00$263.287.1x4,565
Indiana$1,862.20$178.2210.4x19,568
Florida$1,723.75$245.957.0x106,660
Connecticut$1,681.87$244.526.9x14,723
Iowa$1,660.92$200.438.3x10,348
Kansas$1,646.12$225.787.3x10,966
Illinois$1,644.61$200.598.2x52,353
Mississippi$1,630.89$233.067.0x15,601
Tennessee$1,579.82$236.386.7x26,143
Arizona$1,561.98$264.685.9x33,853
Vermont$1,552.90$139.7011.1x2,004
Missouri$1,539.44$186.708.2x20,420
Rhode Island$1,521.33$245.306.2x4,945
Virginia$1,513.26$200.037.6x32,189
Oregon$1,509.89$246.956.1x12,788
Georgia$1,461.45$250.495.8x33,870
Minnesota$1,459.37$200.397.3x14,993
Massachusetts$1,400.23$196.357.1x32,851
Alabama$1,397.23$206.446.8x13,051
Foreign Country$1,342.69$145.539.2x99
Kentucky$1,342.05$185.307.2x15,111
Nebraska$1,319.88$236.515.6x10,206
Maryland$1,296.36$278.514.7x42,794
North Carolina$1,288.72$236.295.5x36,912
Ohio$1,253.81$196.116.4x40,368
Washington$1,240.31$239.705.2x30,067
South Carolina$1,229.13$223.995.5x26,167
New Mexico$1,217.00$232.315.2x6,361
Delaware$1,215.01$249.514.9x5,725
Pennsylvania$1,212.78$224.075.4x57,251
Louisiana$1,173.56$216.675.4x14,516
District of Columbia$1,138.44$178.366.4x2,683
North Dakota$1,099.37$193.335.7x3,166
South Dakota$1,083.73$161.446.7x4,413
Guam$1,071.57$326.923.3x105
Michigan$1,049.78$212.474.9x25,714
Arkansas$1,016.96$223.284.6x9,113
Oklahoma$1,004.09$193.545.2x12,877
Idaho$966.51$183.615.3x6,529
Montana$964.59$191.885.0x4,003
Maine$896.34$132.466.8x2,930
West Virginia$823.42$146.855.6x2,642
Puerto Rico$466.09$293.891.6x842

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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