69100

Biopsy of ear

Medicare pricing data for 15,803 providers across 52 states

🤖AI Overview

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

Biopsy of ear (HCPCS code 69100) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $66.49, but hospitals typically charge $226.47 — a 3.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$13.30

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $66.49, your out-of-pocket cost would be approximately $13.30. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$66.49
Average Hospital Charge
$226.47
Markup Ratio
3.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$226.47
Medicare Allowed$66.49
Medicare Payment$48.85

Hospitals charge 3.4x more than what Medicare allows for this procedure. Medicare actually pays $48.85 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$88$28217108+31.8%
Puerto Rico$81$1051227+21.9%
New Jersey$77$2524754,190+16.2%
Connecticut$76$2541931,302+15.0%
New York$76$2709046,837+14.9%
Maryland$76$2313083,108+14.1%
California$75$2141,37113,862+13.1%
District of Columbia$75$20033213+12.7%
Massachusetts$75$3024663,622+12.3%
Hawaii$73$23937271+9.6%
Colorado$71$2293393,238+7.3%
Delaware$71$15843561+7.1%
Virginia$70$2364144,549+6.0%
Rhode Island$70$21871532+5.2%
Illinois$69$2885124,511+4.4%
Michigan$69$2314723,178+4.3%
Oregon$68$2522301,961+2.5%
Washington$68$2063603,347+2.3%
Pennsylvania$67$2135965,758+1.4%
Louisiana$66$1921551,272-0.3%
Missouri$66$2392682,845-0.8%
Nevada$66$2001391,266-0.9%
Texas$65$2151,07912,365-1.6%
Maine$65$24553571-1.7%
Wyoming$65$23230632-2.1%
New Hampshire$65$302101974-2.1%
Arizona$65$2164567,136-2.6%
Utah$64$1821701,306-3.2%
Georgia$64$2455005,577-3.4%
Idaho$64$1951101,119-3.6%
Ohio$64$2055224,005-3.7%
North Carolina$64$2095976,562-3.9%
Vermont$64$21424147-4.0%
Nebraska$63$223102976-5.1%
New Mexico$63$23065875-5.1%
Florida$63$1951,71228,608-5.2%
Oklahoma$63$2311431,905-5.9%
Indiana$62$2472662,738-6.7%
Kentucky$62$2132062,533-6.7%
Iowa$62$3341631,679-6.8%
North Dakota$62$19934163-7.2%
South Carolina$61$2022564,137-7.6%
Kansas$61$2061432,145-7.9%
West Virginia$60$20185813-9.6%
Alabama$60$2472422,882-10.0%
Minnesota$60$3033081,897-10.2%
Tennessee$59$1993404,474-11.1%
Arkansas$59$1561351,907-11.3%
Montana$58$21972670-12.1%
Wisconsin$58$5762671,751-12.7%
Mississippi$58$208921,682-13.2%
South Dakota$50$15365775-25.1%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber