55874

Injection of biodegradable material next to prostate

Medicare pricing data for 2,556 providers across 50 states

🤖AI Overview

Prices vary significantly by location — from $150 in West Virginia to $3,152 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

Injection of biodegradable material next to prostate (HCPCS code 55874) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,436, but hospitals typically charge $6,879 — a 4.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$287.24

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,436, your out-of-pocket cost would be approximately $287.24. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,436
Average Hospital Charge
$6,879
Markup Ratio
4.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$6,878.75
Medicare Allowed$1,436.20
Medicare Payment$1,142.34

Hospitals charge 4.8x more than what Medicare allows for this procedure. Medicare actually pays $1,142 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$3,152$22,433654+119.5%
Hawaii$2,872$8,7251268+100.0%
District of Columbia$2,450$10,092794+70.6%
Nevada$2,362$8,17116220+64.5%
Maryland$2,334$6,72454508+62.5%
California$2,275$10,4682202,080+58.4%
Delaware$2,139$6,10411176+48.9%
Illinois$1,947$7,97794974+35.5%
New Jersey$1,900$14,49171655+32.3%
Tennessee$1,890$6,37247627+31.6%
New York$1,776$10,4171601,589+23.7%
Oklahoma$1,714$7,24755356+19.3%
Utah$1,635$10,63620203+13.9%
Texas$1,632$6,0271541,436+13.6%
Florida$1,525$7,5122071,702+6.2%
Arizona$1,502$7,936107783+4.6%
Colorado$1,480$5,50239287+3.1%
Alabama$1,401$6,47117117-2.5%
Louisiana$1,385$5,51338232-3.6%
Arkansas$1,334$4,52531241-7.1%
Idaho$1,270$3,910951-11.6%
Oregon$1,253$6,05127122-12.8%
Montana$1,227$3,70019131-14.6%
North Dakota$1,157$5,3308123-19.4%
Nebraska$1,154$5,22643263-19.6%
Missouri$1,141$4,75763505-20.5%
Kansas$1,138$3,36331460-20.8%
Rhode Island$1,093$3,164862-23.9%
South Carolina$1,077$5,37063533-25.0%
Pennsylvania$1,053$4,0841151,006-26.7%
Indiana$1,006$7,75550398-30.0%
Georgia$959$5,11888471-33.3%
Virginia$929$4,47960899-35.3%
Massachusetts$927$3,57658407-35.5%
Washington$924$3,38442374-35.7%
Mississippi$901$3,5851193-37.3%
Kentucky$813$3,01928203-43.4%
North Carolina$785$3,89375445-45.3%
Ohio$701$2,63992599-51.2%
Wisconsin$689$10,93545298-52.0%
Michigan$638$3,78581446-55.6%
New Mexico$525$5,814869-63.4%
Minnesota$418$8,54329326-70.9%
Connecticut$294$6,12949269-79.5%
Maine$164$586312-88.6%
New Hampshire$161$1,082938-88.8%
Wyoming$159$2,404642-88.9%
South Dakota$153$51218108-89.4%
Iowa$153$1,50028186-89.4%
West Virginia$150$9651164-89.6%

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

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💊 Need post-procedure medications? Check costs on OpenPrescriber