49180

Needle biopsy of growth of abdominal cavity

Medicare pricing data for 5,738 providers across 52 states

🤖AI Overview

This procedure has a 7.8x markup — hospitals charge $643.36 but Medicare allows only $82.55. Uninsured patients may face bills 7.8 times higher than what insurance negotiates. 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 growth of abdominal cavity (HCPCS code 49180) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $82.55, but hospitals typically charge $643.36 — a 7.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$16.51

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $82.55, your out-of-pocket cost would be approximately $16.51. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$82.55
Average Hospital Charge
$643.36
Markup Ratio
7.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$643.36
Medicare Allowed$82.55
Medicare Payment$64.80

Hospitals charge 7.8x more than what Medicare allows for this procedure. Medicare actually pays $64.80 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$139$1,5741850+68.5%
Arkansas$103$51059254+25.3%
New Mexico$93$57333100+12.9%
Tennessee$89$581130547+8.4%
California$89$7555292,001+7.4%
New York$89$6863391,342+7.4%
New Jersey$87$556143502+5.2%
Texas$86$8393981,791+3.7%
Maryland$85$466104469+2.6%
Washington$84$316122510+2.3%
Florida$84$7363891,454+2.2%
Nebraska$83$60139263+1.0%
Michigan$83$361185582-0.0%
District of Columbia$82$6381871-0.4%
Massachusetts$82$508149749-1.2%
Montana$82$4452588-1.2%
Connecticut$81$71474227-1.3%
Illinois$81$6782501,061-1.5%
Arizona$80$1,054133503-3.4%
Minnesota$80$711140599-3.6%
Georgia$80$803167479-3.7%
Vermont$79$9891251-3.9%
Delaware$79$2551786-4.0%
Colorado$79$485110251-4.6%
Pennsylvania$79$537257916-4.6%
Oregon$79$39378268-4.7%
New Hampshire$79$7302791-4.8%
Louisiana$78$59565192-5.1%
Missouri$78$618114452-5.2%
Puerto Rico$78$207712-5.5%
Maine$78$3082548-5.7%
Kentucky$78$44468245-5.8%
Rhode Island$78$40333108-6.0%
Nevada$77$98150129-6.1%
Ohio$77$540219768-6.3%
Virginia$77$565144565-6.4%
Kansas$77$37052213-6.5%
Hawaii$77$3191630-6.7%
Indiana$77$520120380-7.0%
Alabama$76$49171216-7.6%
North Carolina$76$612221677-8.0%
Utah$76$32638123-8.3%
South Carolina$76$68681282-8.3%
Oklahoma$75$43358238-8.9%
South Dakota$75$3971696-9.2%
North Dakota$75$6702078-9.3%
Wisconsin$75$1,120156512-9.5%
Iowa$74$60451248-10.0%
Mississippi$74$45043175-10.1%
Idaho$74$59830108-10.4%
Wyoming$73$311716-11.4%
West Virginia$73$35634108-11.6%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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