A9537

Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries

Medicare pricing data for 1,163 providers across 39 states

🤖AI Overview

Prices vary significantly by location — from $9 in Puerto Rico to $121 in Maryland. Where you get this procedure matters more than almost any other factor. 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

Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries (HCPCS code A9537) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $43.35, but hospitals typically charge $142.10 — a 3.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$8.67

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $43.35, your out-of-pocket cost would be approximately $8.67. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$43.35
Average Hospital Charge
$142.10
Markup Ratio
3.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$142.10
Medicare Allowed$43.35
Medicare Payment$34.35

Hospitals charge 3.3x more than what Medicare allows for this procedure. Medicare actually pays $34.35 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$121$21136134+180.1%
Iowa$62$103735+43.2%
Wyoming$62$69622+42.8%
California$62$19787516+42.8%
Michigan$62$105853+42.1%
Massachusetts$62$2516142+41.9%
Indiana$61$499735+39.6%
Idaho$60$194227+38.7%
Nebraska$60$961470+37.5%
Virginia$59$881140+36.3%
Kansas$59$883299+35.8%
Oregon$59$721537+35.3%
Kentucky$58$5331225+34.8%
Washington$58$1193387+34.0%
New Mexico$58$131717+33.3%
Arizona$58$19648378+33.1%
Tennessee$57$10864318+32.5%
Georgia$57$1042697+32.0%
Minnesota$57$2142038+31.3%
Utah$57$95929+30.5%
North Carolina$56$12246201+30.1%
Connecticut$54$991355+25.6%
Missouri$53$9018127+23.2%
South Carolina$52$92331+19.7%
Alabama$51$613484+18.6%
New York$51$11974435+17.8%
New Jersey$50$11255172+14.9%
Ohio$47$1331469+7.9%
Nevada$45$6442205+4.7%
Illinois$44$10231179+1.7%
Texas$40$17387494-7.6%
Mississippi$38$2632063-11.4%
Louisiana$38$143513-12.3%
Colorado$34$61945-21.8%
Wisconsin$31$881128-29.2%
Pennsylvania$30$1511762-29.7%
Arkansas$23$60723-47.6%
Florida$9$1252021,455-78.4%
Puerto Rico$9$98724-78.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber