72126

Ct scan of upper spine with contrast

Medicare pricing data for 6,786 providers across 50 states

🤖AI Overview

This procedure has a 6.0x markup — hospitals charge $381.46 but Medicare allows only $64.07. Uninsured patients may face bills 6.0 times higher than what insurance negotiates. Prices vary significantly by location — from $53 in Iowa to $137 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

Ct scan of upper spine with contrast (HCPCS code 72126) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $64.07, but hospitals typically charge $381.46 — a 6.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$12.81

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $64.07, your out-of-pocket cost would be approximately $12.81. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$64.07
Average Hospital Charge
$381.46
Markup Ratio
6.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$381.46
Medicare Allowed$64.07
Medicare Payment$49.62

Hospitals charge 6.0x more than what Medicare allows for this procedure. Medicare actually pays $49.62 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$137$1,5392184+114.1%
New Jersey$82$447118197+28.5%
Tennessee$79$574188469+23.0%
Nevada$76$5605790+18.6%
Texas$72$5325641,738+12.1%
Arizona$71$519121266+10.5%
New York$70$362337734+10.0%
California$70$4445221,059+9.5%
Washington$68$301167359+6.2%
Utah$68$2814784+5.6%
Georgia$67$440209569+4.6%
Minnesota$67$594206418+4.3%
Nebraska$66$31368125+3.4%
Florida$66$469463974+2.7%
Oregon$66$33678185+2.4%
Oklahoma$64$38285185-0.7%
Alabama$63$332139316-0.9%
Connecticut$63$30982182-1.7%
North Carolina$62$407293689-3.9%
Illinois$62$387226429-4.0%
Maryland$61$285148869-5.1%
District of Columbia$60$1991866-5.9%
Missouri$60$328179582-5.9%
Colorado$59$318122261-7.4%
Kansas$58$22679182-9.1%
Pennsylvania$58$242314960-9.7%
Rhode Island$58$3002035-9.7%
Virginia$58$281201585-9.8%
Massachusetts$58$251160445-9.9%
South Carolina$58$298125320-10.2%
Ohio$57$332232489-10.3%
Indiana$57$319122454-10.5%
Montana$57$1812649-11.2%
New Hampshire$57$6162439-11.5%
Michigan$57$255260844-11.6%
New Mexico$56$2631933-11.9%
Delaware$56$2341831-12.2%
Wyoming$56$3281733-12.4%
Maine$56$1971318-12.7%
Arkansas$56$232109243-13.0%
South Dakota$55$1681634-13.9%
West Virginia$55$3253367-14.5%
Hawaii$55$2501721-14.6%
Louisiana$55$304117310-14.8%
Idaho$54$3533995-15.0%
North Dakota$54$5191033-15.9%
Wisconsin$54$538114207-16.0%
Kentucky$53$22370242-16.9%
Mississippi$53$27654148-17.4%
Iowa$53$2874475-17.7%

⚠️ 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