Everolimus level
Medicare pricing data for 135 providers across 26 states
This procedure has a 14.0x markup — hospitals charge $188.24 but Medicare allows only $13.43. Uninsured patients may face bills 14.0 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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
Everolimus level (HCPCS code 80169) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $13.43, but hospitals typically charge $188.24 — a 14.0x 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 $13.43, your out-of-pocket cost would be approximately $2.69. 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 14.0x more than what Medicare allows for this procedure. Medicare actually pays $13.43 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Florida | $13 | $214 | 5 | 964 | +0.4% |
| Georgia | $13 | $196 | 1 | 57 | +0.2% |
| Hawaii | $13 | $204 | 2 | 43 | +0.2% |
| Illinois | $13 | $194 | 1 | 227 | +0.2% |
| Kansas | $13 | $181 | 6 | 304 | +0.2% |
| Maryland | $13 | $142 | 3 | 141 | +0.2% |
| Massachusetts | $13 | $194 | 3 | 139 | +0.2% |
| Minnesota | $13 | $166 | 20 | 301 | +0.2% |
| New Jersey | $13 | $213 | 4 | 765 | +0.2% |
| New Mexico | $13 | $140 | 1 | 79 | +0.2% |
| New York | $13 | $375 | 3 | 189 | +0.2% |
| North Carolina | $13 | $223 | 3 | 811 | +0.2% |
| Ohio | $13 | $166 | 8 | 252 | +0.2% |
| Oklahoma | $13 | $190 | 3 | 38 | +0.2% |
| Tennessee | $13 | $296 | 2 | 22 | +0.2% |
| Utah | $13 | $134 | 3 | 48 | +0.2% |
| Virginia | $13 | $126 | 6 | 85 | +0.2% |
| Washington | $13 | $222 | 3 | 43 | +0.2% |
| Alabama | $13 | $225 | 2 | 118 | +0.2% |
| Colorado | $13 | $211 | 4 | 37 | +0.2% |
| California | $13 | $150 | 12 | 2,258 | +0.1% |
| Arizona | $13 | $208 | 4 | 646 | -0.1% |
| Texas | $13 | $202 | 9 | 419 | -0.4% |
| Wisconsin | $13 | $82 | 2 | 95 | -0.7% |
| Iowa | $13 | $172 | 2 | 182 | -2.0% |
| Pennsylvania | $13 | $213 | 4 | 203 | -3.4% |
⚠️ 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