52442

Insertion of implant in urethra within prostate gland using an endoscope, each additional implant

Medicare pricing data for 3,041 providers across 51 states

🤖AI Overview

This procedure has a 6.3x markup — hospitals charge $1,906 but Medicare allows only $304.39. Uninsured patients may face bills 6.3 times higher than what insurance negotiates. Prices vary significantly by location — from $45 in Arkansas to $891 in Alaska. 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

Insertion of implant in urethra within prostate gland using an endoscope, each additional implant (HCPCS code 52442) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $304.39, but hospitals typically charge $1,906 — a 6.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$60.88

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $304.39, your out-of-pocket cost would be approximately $60.88. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$304.39
Average Hospital Charge
$1,906
Markup Ratio
6.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,905.71
Medicare Allowed$304.39
Medicare Payment$242.88

Hospitals charge 6.3x more than what Medicare allows for this procedure. Medicare actually pays $242.88 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$891$4,3852157+192.6%
California$628$2,2282837,751+106.3%
New Jersey$563$4,8471263,369+85.1%
Nevada$528$2,28521301+73.3%
New York$509$2,9101913,191+67.3%
Connecticut$508$2,19522439+67.0%
Iowa$504$2,12643955+65.7%
Illinois$489$2,674982,697+60.5%
Utah$451$1,69815380+48.2%
Texas$430$1,7221954,970+41.1%
Arizona$405$1,9361253,592+33.1%
Oregon$404$2,23836991+32.8%
Michigan$381$1,224962,159+25.2%
New Hampshire$373$1,13512471+22.7%
Wisconsin$369$4,90046797+21.2%
North Carolina$359$1,800962,277+17.9%
Minnesota$355$3,00428278+16.6%
Washington$330$1,225552,291+8.3%
Louisiana$322$1,811491,260+5.7%
Tennessee$267$1,7081062,506-12.4%
Indiana$256$2,265711,841-16.0%
Colorado$243$2,309451,517-20.1%
Delaware$238$1,11815313-21.8%
Massachusetts$231$1,61755948-24.0%
South Carolina$180$1,541612,165-40.9%
Nebraska$176$82332981-42.0%
Kansas$153$1,46934751-49.7%
Georgia$142$1,1791212,858-53.3%
Ohio$138$1,1651293,000-54.7%
Florida$130$1,2182396,773-57.2%
Missouri$118$1,420681,271-61.1%
Oklahoma$111$52531936-63.7%
Kentucky$103$85640781-66.2%
Virginia$84$803532,099-72.4%
Pennsylvania$76$1,2951293,159-75.1%
Mississippi$70$1,751391,572-77.0%
District of Columbia$55$1,1744176-81.8%
Maryland$53$3,475792,846-82.5%
Montana$50$28011278-83.6%
Rhode Island$50$1,203545-83.6%
New Mexico$49$1,761670-83.8%
Hawaii$49$9757171-83.9%
Wyoming$48$1,1155122-84.2%
North Dakota$48$6054117-84.2%
Vermont$48$2,1804146-84.2%
West Virginia$48$88513214-84.3%
Maine$48$111491-84.4%
Alabama$47$43230559-84.5%
South Dakota$47$1,0359157-84.6%
Idaho$46$66417477-84.9%
Arkansas$45$84021348-85.1%

⚠️ 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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