0042T

Computed tomography (ct) of brain blood flow, volume, and timing of flow analysis with contrast

Medicare pricing data for 5,499 providers across 52 states

🤖AI Overview

Prices vary significantly by location — from $65 in North Dakota to $277 in Iowa. 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

Computed tomography (ct) of brain blood flow, volume, and timing of flow analysis with contrast (HCPCS code 0042T) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $205.69, but hospitals typically charge $664.84 — a 3.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$41.14

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $205.69, your out-of-pocket cost would be approximately $41.14. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$205.69
Average Hospital Charge
$664.84
Markup Ratio
3.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$664.84
Medicare Allowed$205.69
Medicare Payment$162.76

Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $162.76 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Iowa$277$49852366+34.6%
Kansas$262$67046137+27.3%
District of Columbia$255$1,21321675+24.0%
New Jersey$249$7902123,088+20.9%
Missouri$237$720136556+15.1%
Maryland$230$9451711,912+12.0%
Colorado$228$7711541,909+10.9%
Virginia$226$792127698+10.1%
Puerto Rico$225$270121+9.5%
Pennsylvania$221$9703533,944+7.5%
New Hampshire$221$515866+7.4%
Florida$219$5656719,621+6.6%
Texas$216$5964705,007+5.0%
Vermont$216$1,273413+4.8%
Rhode Island$212$424533+2.9%
West Virginia$206$3932669+0.3%
New Mexico$206$96129221+0.2%
Georgia$206$595132630-0.0%
Mississippi$205$36167769-0.6%
Louisiana$204$349105830-0.8%
North Carolina$203$528166756-1.2%
Tennessee$203$474136637-1.2%
Indiana$202$40189354-1.7%
Connecticut$201$61140264-2.1%
Arkansas$201$76748554-2.2%
South Carolina$200$79869159-2.6%
Alabama$196$53270208-4.7%
Nebraska$190$4632767-7.6%
Michigan$190$550145514-7.7%
New York$185$8191891,020-9.8%
Illinois$181$1,059119575-12.1%
Minnesota$180$474165893-12.4%
Maine$178$5151023-13.3%
Ohio$178$592115371-13.6%
Kentucky$176$35549206-14.7%
Oklahoma$173$37694696-15.7%
Massachusetts$155$86151149-24.4%
Delaware$149$24321476-27.6%
Wisconsin$139$71475159-32.7%
Arizona$128$61294525-37.8%
Oregon$116$54144116-43.4%
Washington$108$42184396-47.5%
Nevada$106$52256190-48.3%
California$102$5795091,949-50.4%
Utah$91$53364159-55.9%
Idaho$85$43153228-58.7%
Hawaii$83$52816122-59.5%
Alaska$79$1,8382279-61.4%
Wyoming$72$177721-65.0%
Montana$66$3072049-68.1%
South Dakota$65$5391321-68.6%
North Dakota$65$9462250-68.6%

⚠️ 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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