Removal of membrane of retina with removal of internal limiting membrane of retina
Medicare pricing data for 3,089 providers across 52 states
Prices vary significantly by location — from $458 in District of Columbia to $2,011 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
Removal of membrane of retina with removal of internal limiting membrane of retina (HCPCS code 67042) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,329, but hospitals typically charge $5,577 — a 4.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,329, your out-of-pocket cost would be approximately $265.73. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 4.2x more than what Medicare allows for this procedure. Medicare actually pays $1,056 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $2,011 | $16,136 | 3 | 35 | +51.4% |
| Indiana | $1,562 | $14,354 | 40 | 697 | +17.5% |
| Wyoming | $1,560 | $9,749 | 2 | 26 | +17.4% |
| Minnesota | $1,542 | $7,456 | 37 | 637 | +16.1% |
| New Hampshire | $1,530 | $7,011 | 9 | 83 | +15.1% |
| Rhode Island | $1,505 | $3,691 | 9 | 52 | +13.3% |
| Washington | $1,446 | $3,605 | 71 | 1,385 | +8.9% |
| California | $1,430 | $6,388 | 349 | 3,226 | +7.6% |
| Florida | $1,428 | $6,586 | 238 | 3,149 | +7.5% |
| Arizona | $1,424 | $3,144 | 64 | 1,712 | +7.1% |
| New Jersey | $1,422 | $6,087 | 82 | 699 | +7.1% |
| Idaho | $1,419 | $3,717 | 12 | 133 | +6.8% |
| South Dakota | $1,419 | $3,763 | 10 | 251 | +6.8% |
| Connecticut | $1,417 | $18,604 | 31 | 263 | +6.7% |
| Colorado | $1,410 | $5,751 | 61 | 929 | +6.1% |
| South Carolina | $1,408 | $6,310 | 44 | 796 | +6.0% |
| Georgia | $1,407 | $5,873 | 64 | 693 | +5.9% |
| Montana | $1,406 | $3,581 | 10 | 126 | +5.8% |
| Hawaii | $1,400 | $4,915 | 15 | 196 | +5.4% |
| Vermont | $1,395 | $4,999 | 5 | 51 | +5.0% |
| Texas | $1,376 | $7,805 | 239 | 3,776 | +3.5% |
| Kansas | $1,375 | $7,426 | 40 | 675 | +3.5% |
| Nebraska | $1,367 | $4,495 | 18 | 358 | +2.9% |
| Pennsylvania | $1,354 | $4,373 | 132 | 1,858 | +1.9% |
| Louisiana | $1,332 | $4,801 | 50 | 569 | +0.2% |
| Utah | $1,329 | $5,840 | 36 | 504 | +0.0% |
| Virginia | $1,320 | $4,192 | 73 | 968 | -0.7% |
| Oregon | $1,307 | $3,142 | 49 | 478 | -1.6% |
| Missouri | $1,305 | $4,577 | 62 | 941 | -1.8% |
| Massachusetts | $1,284 | $3,753 | 116 | 924 | -3.3% |
| New York | $1,277 | $5,165 | 176 | 1,294 | -3.9% |
| Maryland | $1,277 | $5,488 | 87 | 912 | -3.9% |
| Kentucky | $1,267 | $4,782 | 36 | 392 | -4.6% |
| North Dakota | $1,256 | $4,343 | 4 | 111 | -5.5% |
| Nevada | $1,245 | $4,385 | 20 | 201 | -6.3% |
| Tennessee | $1,234 | $6,200 | 70 | 1,504 | -7.1% |
| Delaware | $1,228 | $2,282 | 5 | 49 | -7.6% |
| New Mexico | $1,206 | $2,320 | 14 | 287 | -9.3% |
| Oklahoma | $1,206 | $4,560 | 19 | 468 | -9.3% |
| North Carolina | $1,203 | $3,799 | 87 | 998 | -9.5% |
| Puerto Rico | $1,202 | $1,289 | 13 | 35 | -9.5% |
| Maine | $1,198 | $6,155 | 12 | 125 | -9.9% |
| Mississippi | $1,197 | $3,425 | 24 | 393 | -9.9% |
| Alabama | $1,188 | $3,750 | 43 | 717 | -10.6% |
| Ohio | $1,179 | $4,109 | 121 | 1,903 | -11.3% |
| Michigan | $1,173 | $3,355 | 115 | 934 | -11.7% |
| Iowa | $1,135 | $5,208 | 34 | 748 | -14.5% |
| Illinois | $1,119 | $4,077 | 115 | 1,450 | -15.8% |
| West Virginia | $1,115 | $3,330 | 9 | 90 | -16.1% |
| Wisconsin | $1,067 | $9,123 | 46 | 590 | -19.7% |
| Arkansas | $1,017 | $3,529 | 18 | 132 | -23.5% |
| District of Columbia | $458 | $3,553 | 5 | 35 | -65.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber