Free Tool

What will a procedure really cost?

Pick a procedure and a state to see the Medicare average payment, the typical billed (submitted) charge, and how far the price varies across the country, drawn live from CMS 2023 data.

Source: CMS Medicare Physician & Other Practitioners, 2023

9,297
procedures you can price
56
states & territories compared
Free
no sign-up, instant estimate

Biopsy Of Large Bowel Using A Flexible Endoscope

CPT Code: 45380 · Digestive Surgery

The markup gap

9.0x over Medicare
Medicare pays $189.84
Typical submitted charge $1,709.46

Providers bill about 9.0 times what Medicare actually pays. Uninsured and out-of-network patients are most exposed to the higher figure.

$189.84
National Medicare Avg
$1,709.46
National Submitted Charge
$118.13
National Price Low
$277.68
National Price High

Cost Breakdown

Medicare Average Payment (National) $189.84
Average Submitted Charge (National) $1,709.46
National Price Range $118.13 – $277.68
Total Medicare Services (National) 1,337,772

State Price Comparison

Least Expensive State
Vermont
$118.13
Most Expensive State
Guam
$277.68
# State Medicare Avg Submitted Charge
1 Guam $277.68 $883.01
2 Nevada $250.80 $2,665.58
3 U.S. Virgin Islands $238.56 $2,318.60
4 Puerto Rico $237.21 $454.54
5 Alaska $231.29 $2,886.04
6 California $228.48 $2,283.17
7 New Jersey $225.41 $2,552.51
8 New York $223.80 $2,150.26
9 Maryland $221.59 $1,262.12
10 Arizona $209.54 $1,524.77

Showing top 10 of 54 states. View full state breakdown →

View full procedure details →
Disclaimer: These estimates are based on Medicare Physician Utilization data and reflect Medicare reimbursement rates. Your actual costs may differ significantly based on your insurance plan, provider, facility type, and geographic location. This tool is for informational purposes only and should not be used as a substitute for obtaining actual cost estimates from your healthcare provider or insurance company.

Frequently Asked Questions

How are procedure costs estimated? ▼
Costs are based on actual Medicare Physician Utilization data from CMS (2023). The Medicare average payment reflects what Medicare actually paid providers. Submitted charges are the amounts billed by providers before Medicare adjustments.
Why does the same procedure cost different amounts in different states? ▼
Medicare payment rates vary by geographic region due to differences in local cost of living, practice expenses, and malpractice insurance costs. States with higher costs of living generally have higher Medicare reimbursement rates.
What is the difference between Medicare payment and submitted charge? ▼
The submitted charge is what providers bill (the "sticker price"). The Medicare payment is what Medicare actually pays after applying fee schedules and adjustments. The submitted charge is typically 2–4x higher than the Medicare payment. Patients with private insurance may pay amounts closer to the submitted charge.
Are these the out-of-pocket costs I will pay? ▼
No. These are Medicare reimbursement amounts. Your actual cost depends on your insurance plan, deductible, copay, and whether the provider is in-network. Uninsured patients may face the full submitted charge, while Medicare beneficiaries typically pay 20% coinsurance after meeting their deductible.

Data sources & method

  • Medicare averages - Centers for Medicare & Medicaid Services (CMS), Medicare Physician & Other Practitioners by Provider and Service, Calendar Year 2023. data.cms.gov
  • Commercial & cash estimates - derived from the RAND Hospital Price Transparency Study (4th Edition, 2024) category ratios. These are statistical estimates, not quotes.
  • Figures are computed directly from the source records, see our methodology and editorial policy. Data last updated March 15, 2026.

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.