67028

Injection of drug into eye

Medicare pricing data for 6,551 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 3.5 million services annually. Even small pricing inefficiencies here affect millions of patients. 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 drug into eye (HCPCS code 67028) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $121.19, but hospitals typically charge $569.60 — a 4.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$24.24

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $121.19, your out-of-pocket cost would be approximately $24.24. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$121.19
Average Hospital Charge
$569.60
Markup Ratio
4.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$569.60
Medicare Allowed$121.19
Medicare Payment$91.97

Hospitals charge 4.7x more than what Medicare allows for this procedure. Medicare actually pays $91.97 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$149$1,376103,505+22.8%
New York$132$633459193,019+8.8%
California$131$721861340,562+8.1%
Wyoming$130$29832,933+6.9%
New Jersey$129$52115495,405+6.4%
District of Columbia$129$547203,329+6.3%
Connecticut$129$6827935,979+6.3%
Maryland$127$468159121,508+5.0%
Massachusetts$126$664206102,814+4.0%
Colorado$126$41513559,210+3.9%
Virginia$124$448127100,303+2.1%
Oregon$124$39010555,610+2.0%
Washington$124$42519086,869+1.9%
South Dakota$123$3001716,753+1.6%
Minnesota$122$64413053,426+0.3%
Arizona$121$2778278,338-0.2%
Nevada$121$5673722,808-0.4%
Pennsylvania$121$533279177,192-0.4%
Montana$121$3783018,536-0.4%
Utah$120$4517939,075-1.0%
Florida$120$447439300,367-1.0%
Hawaii$120$587449,413-1.1%
Illinois$120$585268134,964-1.3%
Texas$119$615450233,942-1.9%
Delaware$119$23096,597-2.2%
Kansas$118$6655046,075-2.3%
New Mexico$118$2913820,303-2.4%
Rhode Island$118$5421610,457-2.7%
Puerto Rico$118$174321,458-2.8%
Michigan$118$386236101,411-2.8%
New Hampshire$118$7922411,324-2.9%
South Carolina$118$7107565,714-2.9%
North Carolina$117$609166109,124-3.2%
Tennessee$117$81111494,765-3.4%
Georgia$117$97512765,336-3.7%
Missouri$116$51312363,004-4.5%
Kentucky$115$4997542,385-4.7%
Ohio$115$495225108,543-4.9%
Idaho$115$3773320,859-5.1%
Iowa$115$6278457,085-5.4%
North Dakota$114$5633912,117-5.7%
Alabama$114$4826640,656-6.2%
Maine$114$3963815,371-6.3%
Mississippi$114$5224235,358-6.3%
Indiana$113$56110874,563-6.9%
Oklahoma$112$3585038,261-7.4%
Wisconsin$112$1,21015858,669-7.5%
West Virginia$112$4372613,721-7.7%
Louisiana$110$62410636,624-9.6%
Nebraska$108$4353831,999-11.0%
Vermont$107$48486,778-12.0%
Arkansas$107$5815526,881-12.0%

⚠️ 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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