Review by radiologist of abscess or sinus cavity study
Medicare pricing data for 3,334 providers across 47 states
This procedure has a 5.3x markup — hospitals charge $135.22 but Medicare allows only $25.47. Uninsured patients may face bills 5.3 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
Review by radiologist of abscess or sinus cavity study (HCPCS code 76080) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $25.47, but hospitals typically charge $135.22 — a 5.3x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $25.47, your out-of-pocket cost would be approximately $5.09. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 5.3x more than what Medicare allows for this procedure. Medicare actually pays $20.06 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Massachusetts | $30 | $121 | 123 | 396 | +19.6% |
| New York | $29 | $147 | 231 | 937 | +15.5% |
| California | $28 | $123 | 262 | 1,120 | +8.5% |
| District of Columbia | $27 | $116 | 18 | 54 | +5.2% |
| Maryland | $26 | $102 | 65 | 235 | +2.7% |
| New Jersey | $26 | $141 | 104 | 460 | +2.6% |
| Florida | $26 | $230 | 193 | 548 | +2.3% |
| North Carolina | $26 | $127 | 111 | 245 | +1.1% |
| Illinois | $26 | $143 | 165 | 1,010 | +0.9% |
| Connecticut | $26 | $105 | 54 | 220 | +0.4% |
| Virginia | $25 | $95 | 89 | 271 | -0.1% |
| Washington | $25 | $122 | 66 | 287 | -0.2% |
| Delaware | $25 | $91 | 20 | 60 | -0.4% |
| Pennsylvania | $25 | $110 | 204 | 1,312 | -1.2% |
| Colorado | $25 | $109 | 86 | 300 | -2.1% |
| Montana | $25 | $95 | 10 | 13 | -2.2% |
| Rhode Island | $25 | $83 | 12 | 74 | -2.2% |
| Oregon | $25 | $86 | 40 | 91 | -2.7% |
| Nevada | $25 | $180 | 18 | 39 | -2.9% |
| Texas | $25 | $157 | 197 | 592 | -3.3% |
| Ohio | $24 | $139 | 99 | 238 | -4.3% |
| Michigan | $24 | $98 | 123 | 418 | -4.4% |
| Louisiana | $24 | $94 | 32 | 129 | -4.4% |
| North Dakota | $24 | $86 | 14 | 143 | -4.6% |
| Arizona | $24 | $194 | 45 | 241 | -5.1% |
| New Hampshire | $24 | $289 | 16 | 138 | -5.2% |
| Minnesota | $24 | $159 | 89 | 933 | -5.2% |
| Alabama | $24 | $102 | 26 | 46 | -5.3% |
| South Dakota | $24 | $99 | 16 | 252 | -5.5% |
| South Carolina | $24 | $128 | 28 | 135 | -5.5% |
| Tennessee | $24 | $109 | 51 | 91 | -6.1% |
| Georgia | $24 | $111 | 42 | 82 | -6.2% |
| Oklahoma | $24 | $62 | 27 | 135 | -6.5% |
| Kansas | $24 | $70 | 27 | 70 | -6.8% |
| Mississippi | $24 | $112 | 16 | 83 | -7.1% |
| Utah | $24 | $80 | 34 | 124 | -7.2% |
| Iowa | $24 | $93 | 33 | 372 | -7.3% |
| Missouri | $24 | $141 | 87 | 699 | -7.7% |
| Indiana | $23 | $109 | 78 | 292 | -7.8% |
| Wisconsin | $23 | $222 | 111 | 534 | -8.1% |
| Idaho | $23 | $93 | 21 | 140 | -8.4% |
| Kentucky | $23 | $81 | 36 | 74 | -8.4% |
| New Mexico | $23 | $94 | 27 | 168 | -9.0% |
| Vermont | $23 | $142 | 10 | 136 | -9.2% |
| West Virginia | $23 | $98 | 12 | 14 | -9.5% |
| Nebraska | $23 | $87 | 34 | 242 | -10.3% |
| Arkansas | $22 | $261 | 32 | 181 | -12.9% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber