52356

Crushing of stone of ureter with insertion of stent using an endoscope

Medicare pricing data for 8,178 providers across 52 states

🤖AI Overview

Prices vary significantly by location — from $387 in South Dakota to $1,058 in Maryland. 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

Crushing of stone of ureter with insertion of stent using an endoscope (HCPCS code 52356) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $617.28, but hospitals typically charge $2,813 — a 4.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$123.46

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $617.28, your out-of-pocket cost would be approximately $123.46. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$617.28
Average Hospital Charge
$2,813
Markup Ratio
4.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,813.38
Medicare Allowed$617.28
Medicare Payment$489.18

Hospitals charge 4.6x more than what Medicare allows for this procedure. Medicare actually pays $489.18 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$1,058$4,9221703,151+71.3%
Alaska$995$12,67321298+61.1%
Colorado$825$5,4371591,581+33.7%
Virginia$793$3,0091973,353+28.4%
Oregon$784$2,9811051,397+27.0%
Iowa$765$3,245781,327+23.9%
California$734$3,1546795,849+18.9%
Mississippi$732$2,495681,301+18.6%
Wyoming$713$3,60514219+15.5%
Delaware$693$2,89431418+12.3%
Tennessee$682$2,5001843,208+10.6%
New Jersey$671$3,8943023,081+8.8%
Idaho$658$1,56844611+6.6%
Missouri$649$3,0741701,992+5.2%
Texas$637$3,0675725,387+3.1%
Utah$635$2,40069852+2.8%
Florida$633$2,6916296,811+2.5%
Nevada$628$3,29642608+1.8%
Indiana$628$4,1832102,818+1.8%
Hawaii$622$2,17927213+0.7%
Kansas$595$2,885811,404-3.6%
Georgia$594$2,6262492,749-3.7%
Illinois$594$3,1523123,857-3.8%
Nebraska$591$2,27551805-4.3%
Puerto Rico$586$1,1131523-5.1%
Arizona$580$3,1751742,047-6.0%
Minnesota$567$3,4281621,368-8.1%
Pennsylvania$553$2,0763834,441-10.4%
South Carolina$552$2,6891372,182-10.6%
Ohio$551$1,9873344,019-10.7%
New York$544$2,2484894,254-11.8%
Washington$516$1,5481812,062-16.5%
Alabama$513$2,1471241,276-16.9%
North Carolina$511$1,8602763,044-17.3%
Wisconsin$506$5,6641521,780-18.0%
Kentucky$501$1,633891,277-18.9%
Montana$496$1,56734477-19.6%
Massachusetts$496$1,9352102,468-19.7%
Connecticut$488$2,7091041,007-20.9%
Arkansas$482$1,41251837-21.9%
New Hampshire$464$3,66248538-24.8%
District of Columbia$456$2,32825263-26.2%
Michigan$455$1,5052422,390-26.3%
New Mexico$434$1,46733350-29.6%
Louisiana$426$1,6061341,102-31.0%
Rhode Island$423$1,21329262-31.5%
Oklahoma$414$1,229961,205-33.0%
North Dakota$404$1,67514281-34.6%
Vermont$399$2,05020240-35.4%
West Virginia$397$1,41040505-35.7%
Maine$395$1,14646383-36.0%
South Dakota$387$1,98523368-37.2%

⚠️ 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

💊 Need post-procedure medications? Check costs on OpenPrescriber