Cost analysis for CPT 45378 — Diagnostic exam of large bowel using a flexible endoscope
Average Medicare Payment
$165.63
2023 data
Total Payments (2023)
$49.9M
Services (2023)
258.8K
Price Change (2014–2023)
-9.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $183.64 | $128.9M | 635.5K | — |
| 2015 | $185.46 | $120.8M | 583.2K | +1.0% |
| 2016 | $169.77 | $104.7M | 542.7K | -8.5% |
| 2017 | $155.22 | $82.9M | 494.0K | -8.6% |
| 2018 | $155.44 | $77.0M | 455.3K | +0.1% |
| 2019 | $158.74 | $74.8M | 429.6K | +2.1% |
| 2020 | $159.51 | $53.7M | 307.8K | +0.5% |
| 2021 | $160.12 | $57.8M | 324.4K | +0.4% |
| 2022 | $157.62 | $52.0M | 293.5K | -1.6% |
| 2023 | $165.63 | $49.9M | 258.8K | +5.1% |
The most expensive state pays 2.2x more than the cheapest for this procedure. AK averages $281.65 vs ND at $128.08.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $281.65 | $221.7K | 787 | 30 |
| NY | $230.42 | $5.7M | 24.8K | 689 |
| NV | $230.02 | $730.1K | 3.2K | 72 |
| HI | $224.67 | $170.7K | 760 | 22 |
| PR | $220.72 | $61.8K | 280 | 18 |
| CA | $219.25 | $6.0M | 27.5K | 802 |
| NJ | $214.23 | $2.3M | 10.5K | 336 |
| AZ | $208.67 | $1.1M | 5.3K | 173 |
| MD | $208.35 | $1.8M | 8.6K | 219 |
| OR | $207.08 | $320.6K | 1.5K | 64 |
| DE | $206.88 | $371.4K | 1.8K | 43 |
| RI | $202.98 | $208.7K | 1.0K | 41 |
| CT | $201.43 | $434.7K | 2.2K | 88 |
| FL | $200.43 | $4.4M | 21.7K | 669 |
| CO | $199.09 | $478.6K | 2.4K | 108 |
| WA | $196.38 | $555.7K | 2.8K | 132 |
| NC | $189.67 | $1.5M | 7.8K | 280 |
| TX | $189.01 | $2.8M | 14.8K | 518 |
| GA | $188.23 | $1.6M | 8.4K | 284 |
| PA | $187.17 | $1.8M | 9.6K | 391 |
| WY | $186.00 | $65.7K | 353 | 15 |
| SC | $183.59 | $1.3M | 7.0K | 198 |
| LA | $178.20 | $662.0K | 3.7K | 123 |
| IL | $178.18 | $1.7M | 9.7K | 343 |
| MS | $177.50 | $693.3K | 3.9K | 100 |
| AR | $175.28 | $623.5K | 3.6K | 97 |
| MN | $174.91 | $217.9K | 1.2K | 61 |
| SD | $174.68 | $187.3K | 1.1K | 29 |
| IA | $174.19 | $306.4K | 1.8K | 71 |
| MI | $173.65 | $970.4K | 5.6K | 220 |
| OH | $173.17 | $1.5M | 8.8K | 342 |
| NE | $172.88 | $250.5K | 1.4K | 59 |
| TN | $172.08 | $1.3M | 7.7K | 233 |
| VA | $171.09 | $962.7K | 5.6K | 212 |
| ID | $169.41 | $138.4K | 817 | 34 |
| NH | $167.78 | $235.9K | 1.4K | 60 |
| NM | $167.52 | $189.0K | 1.1K | 37 |
| UT | $166.91 | $230.0K | 1.4K | 50 |
| KS | $165.73 | $601.6K | 3.6K | 119 |
| MA | $164.39 | $980.9K | 6.0K | 209 |
| OK | $164.39 | $521.6K | 3.2K | 112 |
| DC | $163.32 | $86.4K | 529 | 28 |
| IN | $162.49 | $665.1K | 4.1K | 180 |
| MO | $160.94 | $805.7K | 5.0K | 205 |
| AL | $160.91 | $842.9K | 5.2K | 171 |
| VT | $154.64 | $36.5K | 236 | 11 |
| WI | $148.12 | $260.3K | 1.8K | 90 |
| KY | $147.27 | $542.0K | 3.7K | 149 |
| MT | $144.69 | $103.3K | 714 | 29 |
| ME | $140.39 | $70.9K | 505 | 27 |
| WV | $133.44 | $199.9K | 1.5K | 57 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Bel Air Endoscopy Asc Llc | Ambulatory Surgical Center | MD | $194.1K | 609 | $318.67 |
| Gastro Operating Company Llc | Ambulatory Surgical Center | NY | $180.9K | 471 | $384.12 |
| Brooklyn Sc Llc | Ambulatory Surgical Center | NY | $140.2K | 349 | $401.61 |
| Dallas Endoscopy Center, Ltd | Ambulatory Surgical Center | TX | $137.6K | 411 | $334.85 |
| Elms Endoscopy Center Llc | Ambulatory Surgical Center | SC | $114.6K | 378 | $303.06 |
| Digestivecare, Llc | Ambulatory Surgical Center | TN | $113.3K | 385 | $294.28 |
| Medstar Medical Group - Southern Maryland Llc | Ambulatory Surgical Center | MD | $108.9K | 340 | $320.26 |
| Endoscopy Center Of Santa Maria Inc | Ambulatory Surgical Center | CA | $108.5K | 258 | $420.49 |
| Nhpe, Llc | Ambulatory Surgical Center | NY | $101.6K | 272 | $373.66 |
| Athens Gastroenterology Endoscopy Center Inc | Ambulatory Surgical Center | GA | $101.2K | 305 | $331.79 |
| Digestive Disease Center Of Central New York, Llc | Ambulatory Surgical Center | NY | $100.4K | 297 | $338.16 |
| Kips Bay Endoscopy Center, Llc | Ambulatory Surgical Center | NY | $94.0K | 242 | $388.30 |
| West Side Gi, Llc | Ambulatory Surgical Center | NY | $93.9K | 249 | $376.91 |
| East Valley Endoscopy Llc | Ambulatory Surgical Center | AZ | $87.2K | 273 | $319.56 |
| Murdock Ambulatory Surgery Center Llc | Ambulatory Surgical Center | FL | $86.4K | 283 | $305.40 |
| Digestive Disease Center | Ambulatory Surgical Center | NV | $86.4K | 236 | $366.07 |
| Physicians Surgery Center At Glendale Adventist, Llc | Ambulatory Surgical Center | CA | $82.8K | 228 | $363.19 |
| Specialty Surgical Center Of Beverly Hills Lp | Ambulatory Surgical Center | CA | $80.9K | 211 | $383.62 |
| Chevy Chase Ambulatory Center Lp | Ambulatory Surgical Center | CA | $80.0K | 204 | $392.25 |
| Sierra Endoscopy Center, Llc | Ambulatory Surgical Center | CA | $78.4K | 209 | $375.05 |
The data suggests significant pricing inconsistencies for CPT 45378. With a 2.2x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
While costs have decreased 9.8% since 2014, the wide state-by-state variation suggests the pricing formula may not adequately account for regional differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.