37243

Occlusion of growths or obstructed vessels with review by radiologist

Medicare pricing data for 2,588 providers across 50 states

🤖AI Overview

This procedure has a 5.8x markup — hospitals charge $14,282 but Medicare allows only $2,454. Uninsured patients may face bills 5.8 times higher than what insurance negotiates. Prices vary significantly by location — from $474 in West Virginia to $5,911 in Virginia. 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

Occlusion of growths or obstructed vessels with review by radiologist (HCPCS code 37243) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $2,454, but hospitals typically charge $14,282 — a 5.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$490.74

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $2,454, your out-of-pocket cost would be approximately $490.74. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$2,454
Average Hospital Charge
$14,282
Markup Ratio
5.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$14,282.07
Medicare Allowed$2,453.71
Medicare Payment$1,955.07

Hospitals charge 5.8x more than what Medicare allows for this procedure. Medicare actually pays $1,955 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Virginia$5,911$18,73982858+140.9%
Massachusetts$4,668$14,43673628+90.2%
Arizona$4,011$17,01960471+63.5%
New York$3,854$24,0591961,327+57.1%
New Mexico$3,810$20,18621103+55.3%
North Carolina$3,640$19,19989756+48.3%
New Jersey$3,058$12,37775353+24.6%
Texas$2,894$11,2961911,001+17.9%
Colorado$2,846$12,96362356+16.0%
Arkansas$2,729$15,75423138+11.2%
Missouri$2,728$13,55656413+11.2%
Illinois$2,657$8,805115612+8.3%
Kentucky$2,547$6,57227172+3.8%
Pennsylvania$2,521$14,5981291,196+2.7%
Tennessee$2,421$16,75253435-1.3%
Mississippi$2,294$15,1171085-6.5%
Indiana$2,139$10,15950239-12.8%
Oklahoma$2,045$11,43732180-16.7%
Washington$1,835$7,90866272-25.2%
Michigan$1,702$5,94679304-30.7%
Florida$1,354$10,3021851,178-44.8%
Minnesota$1,240$15,66946187-49.5%
California$1,239$24,9732561,441-49.5%
Maryland$1,151$4,10245355-53.1%
Oregon$1,000$4,61749280-59.2%
Georgia$802$15,16360273-67.3%
Alaska$735$7,288429-70.0%
Nebraska$627$6,9601587-74.5%
District of Columbia$583$7,8941055-76.2%
Connecticut$571$3,99622108-76.7%
Rhode Island$560$8,563941-77.2%
Vermont$556$35,147729-77.3%
Delaware$552$1,8401068-77.5%
Montana$551$2,7341057-77.5%
Nevada$549$5,0711770-77.6%
Hawaii$547$1,713820-77.7%
Louisiana$546$16,18427207-77.7%
Ohio$542$5,95570299-77.9%
New Hampshire$540$8,5441234-78.0%
Maine$538$1,927716-78.1%
Utah$532$14,7561766-78.3%
North Dakota$531$4,9361034-78.4%
South Carolina$528$5,79431231-78.5%
Alabama$518$4,13519136-78.9%
Idaho$516$4,2351355-79.0%
Wisconsin$515$11,58463271-79.0%
South Dakota$515$1,392852-79.0%
Iowa$511$9,88419100-79.2%
Kansas$502$2,89017111-79.5%
West Virginia$474$1,819845-80.7%

⚠️ 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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