78434

Nuclear medicine study of heart muscle blood flow by pet

Medicare pricing data for 1,515 providers across 44 states

🤖AI Overview

Prices vary significantly by location — from $28 in Indiana to $176 in Maryland. 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

Nuclear medicine study of heart muscle blood flow by pet (HCPCS code 78434) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $120.90, but hospitals typically charge $427.20 — a 3.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$24.18

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $120.90, your out-of-pocket cost would be approximately $24.18. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$120.90
Average Hospital Charge
$427.20
Markup Ratio
3.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$427.20
Medicare Allowed$120.90
Medicare Payment$96.28

Hospitals charge 3.5x more than what Medicare allows for this procedure. Medicare actually pays $96.28 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$176$1,118242,414+45.4%
Delaware$172$1,20471,704+42.2%
Florida$170$42617211,727+40.5%
New Jersey$168$369463,315+38.7%
Texas$156$45814412,404+28.9%
Mississippi$156$556132,293+28.8%
Louisiana$147$284605,746+21.5%
Pennsylvania$142$5381246,531+17.3%
Kansas$137$325332,249+13.6%
California$133$34713818,272+10.2%
Wisconsin$124$1,3755228+2.9%
Nevada$120$372624,163-0.3%
New York$118$362899,504-2.2%
Washington$115$34220612-4.9%
Illinois$112$6684414,189-7.3%
Virginia$112$21026743-7.6%
Oregon$94$4338679-22.1%
Arkansas$72$15361,266-40.6%
Arizona$71$168372,150-41.0%
Alabama$57$24110635-53.1%
Connecticut$49$13125449-59.6%
Tennessee$42$10435771-65.2%
Utah$40$531483,612-67.1%
Maine$37$11120405-69.3%
Michigan$36$153181,034-69.9%
Massachusetts$32$12422665-73.9%
Ohio$29$12029963-75.7%
Colorado$29$9823581-75.8%
District of Columbia$29$104252-75.9%
New Hampshire$29$1487389-76.0%
North Dakota$29$896636-76.2%
South Dakota$29$807635-76.2%
Kentucky$29$88491-76.3%
Minnesota$29$9845491-76.4%
Vermont$28$1355226-76.5%
Missouri$28$143263,220-76.5%
Georgia$28$430782,973-76.6%
Idaho$28$60138-76.6%
New Mexico$28$175425-76.7%
West Virginia$28$85620-76.7%
Iowa$28$97119-76.8%
North Carolina$28$11012295-77.0%
Oklahoma$28$365247-77.0%
Indiana$28$8217711-77.2%

⚠️ 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