67515

Injection of drug or substance into membrane covering eyeball

Medicare pricing data for 2,663 providers across 48 states

🤖AI Overview

This procedure has a 5.0x markup — hospitals charge $240.38 but Medicare allows only $47.85. Uninsured patients may face bills 5.0 times higher than what insurance negotiates. 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 or substance into membrane covering eyeball (HCPCS code 67515) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $47.85, but hospitals typically charge $240.38 — a 5.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$9.57

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $47.85, your out-of-pocket cost would be approximately $9.57. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$47.85
Average Hospital Charge
$240.38
Markup Ratio
5.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$240.38
Medicare Allowed$47.85
Medicare Payment$36.05

Hospitals charge 5.0x more than what Medicare allows for this procedure. Medicare actually pays $36.05 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$59$211530+22.5%
New Hampshire$56$274534+17.6%
New York$54$249131836+13.0%
New Jersey$54$31273370+12.9%
Massachusetts$54$27168348+12.7%
Connecticut$53$33729176+10.0%
Washington$52$20954232+8.2%
Rhode Island$52$228734+8.2%
Delaware$52$90414+7.9%
New Mexico$52$1671534+7.8%
Montana$52$1561155+7.7%
Illinois$51$20287508+6.6%
Minnesota$51$34459420+6.0%
South Dakota$51$1301153+5.7%
Maine$51$190721+5.7%
Pennsylvania$50$325117932+4.8%
Kentucky$50$16625149+4.5%
West Virginia$50$176655+4.3%
South Carolina$50$15736336+3.9%
Nevada$50$1771577+3.7%
Michigan$49$19784436+3.1%
Puerto Rico$49$60744+3.0%
Alabama$49$14236252+2.4%
Ohio$49$217108701+2.2%
Virginia$49$21869482+1.8%
Louisiana$49$20850261+1.7%
Georgia$48$39159344+1.2%
North Carolina$48$18197635+1.2%
Florida$48$1892381,824+1.1%
Wisconsin$48$59453204+0.5%
Indiana$48$17836319+0.4%
Idaho$48$2321173+0.1%
Kansas$48$20824201-0.6%
Hawaii$48$15411157-0.6%
Arizona$48$32563452-0.7%
California$47$2252832,851-0.9%
Maryland$47$18270492-1.1%
Arkansas$47$22225206-1.4%
Iowa$47$23319123-1.6%
Nebraska$46$2231133-3.8%
Texas$45$294173969-5.4%
Tennessee$45$37972579-6.4%
Mississippi$44$18230336-7.8%
Utah$44$19731224-7.9%
Missouri$44$18657365-8.5%
Oklahoma$42$18718212-11.5%
Oregon$38$30549280-19.7%
Colorado$36$23365718-24.2%

⚠️ 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