Needle biopsy of muscle
Medicare pricing data for 6,758 providers across 52 states
This procedure has a 8.0x markup — hospitals charge $542.76 but Medicare allows only $67.71. Uninsured patients may face bills 8.0 times higher than what insurance negotiates. Prices vary significantly by location — from $47 in Idaho to $112 in Arkansas. 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
Needle biopsy of muscle (HCPCS code 20206) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $67.71, but hospitals typically charge $542.76 — a 8.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $67.71, your out-of-pocket cost would be approximately $13.54. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 8.0x more than what Medicare allows for this procedure. Medicare actually pays $52.86 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Arkansas | $112 | $592 | 57 | 152 | +64.8% |
| Nevada | $92 | $628 | 61 | 112 | +35.7% |
| Connecticut | $86 | $594 | 87 | 175 | +26.8% |
| California | $83 | $813 | 630 | 1,616 | +22.5% |
| New Hampshire | $81 | $629 | 48 | 113 | +19.9% |
| Maryland | $80 | $499 | 115 | 285 | +18.8% |
| New Mexico | $79 | $580 | 42 | 89 | +17.3% |
| New York | $78 | $699 | 405 | 1,155 | +15.7% |
| Arizona | $77 | $775 | 150 | 453 | +13.2% |
| Washington | $74 | $319 | 149 | 377 | +8.6% |
| New Jersey | $73 | $498 | 157 | 394 | +8.3% |
| Nebraska | $73 | $558 | 40 | 140 | +8.3% |
| Florida | $73 | $585 | 493 | 1,312 | +7.6% |
| Oregon | $71 | $450 | 91 | 199 | +4.3% |
| Tennessee | $69 | $459 | 158 | 388 | +2.0% |
| Kansas | $68 | $308 | 67 | 182 | +0.5% |
| South Carolina | $67 | $352 | 114 | 264 | -0.5% |
| North Carolina | $65 | $510 | 221 | 415 | -3.5% |
| Texas | $64 | $540 | 460 | 1,196 | -4.8% |
| Alaska | $64 | $777 | 17 | 49 | -6.1% |
| Georgia | $63 | $567 | 194 | 382 | -6.7% |
| Minnesota | $63 | $603 | 177 | 456 | -7.1% |
| Massachusetts | $61 | $353 | 201 | 561 | -9.5% |
| Michigan | $61 | $332 | 196 | 467 | -10.1% |
| District of Columbia | $61 | $508 | 25 | 56 | -10.2% |
| Hawaii | $61 | $221 | 17 | 49 | -10.6% |
| Pennsylvania | $59 | $359 | 320 | 812 | -12.7% |
| Virginia | $58 | $369 | 194 | 486 | -15.0% |
| Indiana | $58 | $383 | 140 | 339 | -15.0% |
| Illinois | $57 | $652 | 280 | 757 | -15.3% |
| Wisconsin | $57 | $1,074 | 171 | 430 | -15.6% |
| Montana | $56 | $248 | 24 | 59 | -17.4% |
| Ohio | $56 | $377 | 241 | 512 | -17.9% |
| Delaware | $56 | $198 | 21 | 86 | -17.9% |
| Wyoming | $54 | $602 | 7 | 19 | -19.8% |
| Colorado | $54 | $357 | 114 | 239 | -20.5% |
| Missouri | $54 | $453 | 156 | 417 | -21.0% |
| Puerto Rico | $53 | $288 | 5 | 13 | -21.9% |
| Maine | $53 | $250 | 29 | 73 | -22.3% |
| Rhode Island | $53 | $517 | 31 | 69 | -22.4% |
| West Virginia | $52 | $267 | 35 | 112 | -22.9% |
| North Dakota | $52 | $701 | 19 | 50 | -23.0% |
| Alabama | $52 | $394 | 88 | 178 | -23.4% |
| Louisiana | $52 | $459 | 67 | 128 | -23.5% |
| Vermont | $52 | $778 | 14 | 33 | -23.9% |
| Utah | $51 | $321 | 42 | 73 | -24.3% |
| Iowa | $51 | $589 | 59 | 154 | -24.5% |
| South Dakota | $51 | $627 | 16 | 50 | -25.3% |
| Oklahoma | $50 | $446 | 68 | 167 | -26.5% |
| Kentucky | $49 | $323 | 67 | 165 | -27.5% |
| Mississippi | $49 | $369 | 50 | 143 | -27.9% |
| Idaho | $47 | $335 | 47 | 116 | -30.3% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber