68841

Insertion of drug delivery implant into tear duct of eye

Medicare pricing data for 1,140 providers across 41 states

🤖AI Overview

This procedure has a 12.7x markup — hospitals charge $213.96 but Medicare allows only $16.85. Uninsured patients may face bills 12.7 times higher than what insurance negotiates. Prices vary significantly by location — from $15 in Tennessee to $49 in South Dakota. 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

Insertion of drug delivery implant into tear duct of eye (HCPCS code 68841) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $16.85, but hospitals typically charge $213.96 — a 12.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.37

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $16.85, your out-of-pocket cost would be approximately $3.37. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$16.85
Average Hospital Charge
$213.96
Markup Ratio
12.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$213.96
Medicare Allowed$16.85
Medicare Payment$13.44

Hospitals charge 12.7x more than what Medicare allows for this procedure. Medicare actually pays $13.44 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
South Dakota$49$501316+192.3%
Pennsylvania$20$490472,828+17.6%
Florida$19$1831046,131+13.9%
New York$19$211844,521+11.8%
New Jersey$18$2131039,902+6.4%
California$18$286664,309+4.9%
Connecticut$18$164211,373+4.1%
Texas$17$259784,448+3.6%
Maryland$17$11218931+1.8%
Massachusetts$17$168332,543+1.8%
Illinois$17$182362,795-0.1%
New Hampshire$17$1506410-0.4%
Michigan$17$213501,938-0.7%
Colorado$17$135438-0.8%
Arkansas$17$1266251-2.0%
Rhode Island$16$1623492-2.1%
Wyoming$16$1941240-3.4%
Utah$16$3403114-3.7%
Delaware$16$5521,003-4.3%
Kansas$16$195162,004-4.3%
Ohio$16$341511,200-4.6%
Virginia$16$239336,852-4.9%
Washington$16$76358-4.9%
Nevada$16$1469371-5.2%
Minnesota$16$3074217-5.3%
Arizona$16$93327,831-5.5%
Alabama$16$20414607-5.5%
Georgia$16$389282,089-5.6%
Missouri$16$426231,784-6.3%
Kentucky$16$39614859-7.1%
New Mexico$16$20641,299-7.3%
North Carolina$16$169283,283-8.0%
Oklahoma$15$8416577-8.1%
Louisiana$15$27911666-8.6%
Wisconsin$15$174281,503-8.7%
Iowa$15$918800-9.1%
Nebraska$15$464735-9.6%
South Carolina$15$134252,482-9.7%
Indiana$15$258392,717-9.9%
Mississippi$15$208333,243-11.2%
Tennessee$15$87141,117-11.5%

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

Related from TheDataProject.ai

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