97028

Application of ultraviolet light

Medicare pricing data for 92 providers across 9 states

🤖AI Overview

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

Application of ultraviolet light (HCPCS code 97028) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $6.72, but hospitals typically charge $30.14 — a 4.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.34

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $6.72, your out-of-pocket cost would be approximately $1.34. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$6.72
Average Hospital Charge
$30.14
Markup Ratio
4.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$30.14
Medicare Allowed$6.72
Medicare Payment$5.15

Hospitals charge 4.5x more than what Medicare allows for this procedure. Medicare actually pays $5.15 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
South Dakota$8$1257151+17.3%
Nebraska$8$15272+14.9%
Iowa$8$146886+13.5%
Colorado$7$14146+11.5%
Texas$7$847171+2.2%
New York$7$50102,738+1.5%
Illinois$7$26171,699+0.7%
California$6$8171,925-7.9%
Florida$6$82371-8.0%

⚠️ 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