68761

Closure of tear duct opening using plug

Medicare pricing data for 15,481 providers across 52 states

🤖AI Overview

Prices vary significantly by location — from $84 in Wyoming to $208 in District of Columbia. 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

Closure of tear duct opening using plug (HCPCS code 68761) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $140.39, but hospitals typically charge $347.26 — a 2.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$28.08

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $140.39, your out-of-pocket cost would be approximately $28.08. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$140.39
Average Hospital Charge
$347.26
Markup Ratio
2.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$347.26
Medicare Allowed$140.39
Medicare Payment$107.33

Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $107.33 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$208$56326188+48.2%
New Jersey$204$42253517,290+45.2%
Delaware$202$43747590+44.0%
Maryland$189$4042896,694+34.5%
Pennsylvania$178$39375715,111+27.1%
Texas$178$44095014,544+26.9%
Louisiana$178$4862213,708+26.7%
Mississippi$176$5341452,355+25.6%
Colorado$176$4073164,324+25.2%
New Mexico$172$40794788+22.3%
Connecticut$170$4642193,533+21.2%
Wisconsin$166$7852542,433+18.0%
Arkansas$161$3691491,844+14.7%
Oklahoma$160$3142342,455+14.2%
Alaska$156$59146301+10.9%
New York$155$3711,17654,772+10.6%
South Dakota$155$3641081,381+10.4%
Oregon$154$4222031,825+9.7%
Montana$153$26181885+8.9%
Washington$150$3743653,730+6.9%
Minnesota$150$5422471,674+6.7%
Vermont$149$41630190+6.3%
Massachusetts$149$5374038,096+5.9%
Rhode Island$148$344982,400+5.5%
Virginia$143$38241910,095+1.6%
Puerto Rico$139$18417178-0.9%
New Hampshire$136$341831,389-2.9%
California$135$3311,516104,894-3.7%
Utah$131$3051833,207-6.7%
Michigan$131$3264007,962-6.7%
Nebraska$129$3691151,031-8.1%
Ohio$128$3024165,669-8.7%
Idaho$128$331103974-8.9%
Nevada$128$3751378,118-9.0%
Kentucky$127$2991801,828-9.3%
West Virginia$125$31690973-10.8%
Georgia$125$4543735,943-11.2%
Missouri$124$2942412,341-11.6%
South Carolina$123$3852083,824-12.0%
North Carolina$123$3154448,168-12.2%
Florida$123$3061,10978,025-12.3%
North Dakota$123$34762703-12.4%
Indiana$122$3272574,389-13.2%
Maine$121$25647469-13.6%
Illinois$121$30757816,197-14.1%
Arizona$120$24835615,302-14.9%
Tennessee$118$2433617,500-15.9%
Iowa$118$3012363,103-16.0%
Kansas$113$3181714,287-19.3%
Hawaii$111$305753,743-20.8%
Alabama$106$2322274,383-24.5%
Wyoming$84$152296,460-40.1%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber