45385

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

Code 45385. Medicare covered 1,564,543 of these. Here is what providers billed and what Medicare allowed, state by state.

$1,838.87Billed, national avg
$360.17Medicare allowed
5.1xBilled vs allowed
6.6xHighest vs lowest state

Providers in Alaska billed the most for this, at $3,611.76. In Puerto Rico the average was $550.45. 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$3,611.76$468.947.7x4,431
Wisconsin$3,370.73$290.3511.6x25,619
Virgin Islands$2,906.71$296.169.8x212
New Jersey$2,781.55$411.896.8x47,752
New Hampshire$2,747.77$312.318.8x11,033
Nevada$2,604.43$407.526.4x10,966
California$2,435.03$432.315.6x153,413
Colorado$2,420.03$383.466.3x29,267
Texas$2,385.12$357.016.7x109,651
Indiana$2,376.76$321.647.4x38,055
New York$2,373.49$397.906.0x71,303
Utah$2,329.95$328.067.1x9,329
Wyoming$2,173.68$378.105.7x2,709
Hawaii$1,966.30$419.234.7x4,339
Florida$1,872.24$368.815.1x120,817
Connecticut$1,834.22$377.734.9x17,084
Illinois$1,819.82$330.355.5x59,162
Iowa$1,818.75$323.635.6x17,589
Mississippi$1,818.11$337.945.4x18,541
Kansas$1,768.01$323.925.5x14,818
Rhode Island$1,721.01$382.654.5x5,756
Missouri$1,669.87$312.895.3x30,060
Arizona$1,663.67$372.724.5x33,792
Vermont$1,628.23$286.835.7x3,262
Tennessee$1,618.45$336.624.8x35,666
Foreign Country$1,610.88$232.486.9x58
Oregon$1,603.60$377.814.2x19,565
Minnesota$1,592.03$332.214.8x23,293
Massachusetts$1,525.46$324.814.7x44,540
Virginia$1,521.37$321.694.7x39,327
Delaware$1,518.05$384.793.9x10,458
Alabama$1,508.22$308.554.9x16,628
Georgia$1,411.43$365.853.9x43,232
Ohio$1,395.74$338.954.1x58,847
South Carolina$1,391.96$344.824.0x37,768
Maryland$1,385.90$397.633.5x43,502
Nebraska$1,379.62$354.833.9x15,356
South Dakota$1,375.33$291.714.7x6,013
New Mexico$1,372.64$355.003.9x6,401
North Carolina$1,370.15$361.713.8x65,201
Kentucky$1,344.23$305.604.4x20,934
Pennsylvania$1,337.31$354.073.8x77,784
Louisiana$1,288.73$337.763.8x23,513
Washington$1,276.37$373.493.4x39,472
North Dakota$1,257.43$269.704.7x3,804
Arkansas$1,199.72$328.463.7x15,471
District of Columbia$1,141.85$311.973.7x2,881
Idaho$1,136.41$336.883.4x9,447
Oklahoma$1,133.09$317.653.6x15,037
Montana$1,131.63$308.003.7x5,729
Michigan$1,106.59$335.333.3x35,342
West Virginia$1,047.84$247.024.2x4,090
Maine$1,036.72$291.303.6x5,342
Guam$940.10$384.712.4x126
Puerto Rico$550.45$382.741.4x730

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

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