38792

Injection of radioactive material for x-ray identification of lymph node

Medicare pricing data for 5,400 providers across 52 states

🤖AI Overview

This procedure has a 9.5x markup — hospitals charge $268.75 but Medicare allows only $28.26. Uninsured patients may face bills 9.5 times higher than what insurance negotiates. Prices vary significantly by location — from $18 in Vermont to $52 in New Mexico. 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

Injection of radioactive material for x-ray identification of lymph node (HCPCS code 38792) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $28.26, but hospitals typically charge $268.75 — a 9.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.65

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $28.26, your out-of-pocket cost would be approximately $5.65. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$28.26
Average Hospital Charge
$268.75
Markup Ratio
9.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$268.75
Medicare Allowed$28.26
Medicare Payment$22.25

Hospitals charge 9.5x more than what Medicare allows for this procedure. Medicare actually pays $22.25 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Mexico$52$1811799+85.1%
Kansas$44$19475371+55.0%
Alaska$39$3472387+37.4%
Maryland$38$19495715+34.2%
California$37$2944241,983+31.7%
Arkansas$34$15663330+20.4%
Florida$34$2062541,598+18.9%
Hawaii$31$104850+9.0%
Tennessee$31$186148743+8.1%
New Jersey$30$238206818+6.8%
Illinois$30$394196819+6.2%
Michigan$30$141162642+4.9%
Washington$30$145128786+4.6%
Nevada$29$41145157+3.4%
New York$29$4222421,509+3.4%
South Dakota$29$2141862+1.7%
Virginia$28$282138943-1.5%
Oregon$28$15687358-1.6%
Missouri$28$28396443-1.8%
South Carolina$27$52997460-3.4%
Texas$27$4453241,496-4.6%
Mississippi$27$25554348-5.3%
Massachusetts$26$242150604-6.3%
Wyoming$26$2261763-7.4%
Montana$26$1192487-8.4%
New Hampshire$25$42138163-10.3%
Rhode Island$25$1681219-10.5%
Oklahoma$25$11338245-10.8%
Pennsylvania$25$2252491,410-11.6%
Colorado$25$268116522-11.6%
North Carolina$25$2102091,025-12.8%
Wisconsin$25$544164497-13.0%
Iowa$24$178110438-13.6%
Kentucky$24$21770308-13.9%
Louisiana$24$199121450-14.0%
Minnesota$24$251149622-14.6%
Arizona$24$279102760-15.4%
Nebraska$24$17157259-15.9%
Alabama$24$272106318-16.0%
North Dakota$24$2521692-16.8%
Idaho$23$22838129-16.9%
Georgia$23$317128488-17.3%
Indiana$22$232112578-21.2%
Ohio$22$1922351,115-22.1%
District of Columbia$21$1701462-24.6%
Connecticut$21$32474286-25.5%
Maine$21$2481232-25.6%
West Virginia$20$28632105-28.1%
Delaware$20$13017170-30.4%
Puerto Rico$18$57711-35.3%
Utah$18$15333240-35.6%
Vermont$18$37812101-37.8%

⚠️ 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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