A9596

Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie

Medicare pricing data for 635 providers across 40 states

🤖AI Overview

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

Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie (HCPCS code A9596) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,021, but hospitals typically charge $2,196 — a 2.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$204.11

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,021, your out-of-pocket cost would be approximately $204.11. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,021
Average Hospital Charge
$2,196
Markup Ratio
2.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,195.69
Medicare Allowed$1,020.53
Medicare Payment$813.08

Hospitals charge 2.2x more than what Medicare allows for this procedure. Medicare actually pays $813.08 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Oklahoma$1,266$4,8828408+24.1%
North Carolina$1,214$2,74210111+19.0%
New Mexico$1,157$1,254192+13.3%
Illinois$1,074$2,13461,142+5.2%
Virginia$1,070$1,48412732+4.8%
Arkansas$1,065$2,570411,756+4.3%
Idaho$1,062$2,53114912+4.1%
Utah$1,054$3,7601221+3.3%
District of Columbia$1,054$3,469175+3.3%
Minnesota$1,054$2,052683+3.3%
Missouri$1,054$2,350163+3.3%
Indiana$1,053$1,1626171+3.2%
Wyoming$1,053$3,7603327+3.2%
New York$1,050$2,498371,513+2.9%
Arizona$1,047$1,88223590+2.6%
Washington$1,046$2,459152,128+2.5%
California$1,045$2,353584,285+2.4%
Oregon$1,044$1,8403830+2.3%
Alaska$1,040$2,24312915+1.9%
Nebraska$1,038$2,495151,761+1.7%
Hawaii$1,037$1,66831,404+1.6%
Mississippi$1,036$1,8401274+1.6%
Michigan$1,036$1,1841340+1.5%
Tennessee$1,034$2,067272,032+1.3%
Massachusetts$1,033$1,69724730+1.2%
Louisiana$1,029$3,821898+0.8%
Puerto Rico$1,023$1,0513170+0.3%
Texas$990$2,859593,418-3.0%
Iowa$987$1,070231,127-3.3%
Wisconsin$986$2,18412286-3.4%
Georgia$982$2,7506170-3.8%
Maryland$982$1,66314980-3.8%
Florida$980$2,0751068,212-4.0%
Kansas$977$1,1632603-4.2%
Alabama$975$1,2957120-4.4%
Ohio$955$1,1095235-6.4%
Kentucky$945$1,4213301-7.4%
Nevada$936$1,12013402-8.3%
Pennsylvania$907$1,19715309-11.1%
Colorado$881$2,95614375-13.6%

⚠️ 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