G0426

Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth

Medicare pricing data for 2,815 providers across 46 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

Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth (HCPCS code G0426) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $124.10, but hospitals typically charge $349.31 — a 2.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$24.82

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $124.10, your out-of-pocket cost would be approximately $24.82. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$124.10
Average Hospital Charge
$349.31
Markup Ratio
2.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$349.31
Medicare Allowed$124.10
Medicare Payment$97.03

Hospitals charge 2.8x more than what Medicare allows for this procedure. Medicare actually pays $97.03 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$148$390222+19.0%
District of Columbia$139$363357+11.9%
Rhode Island$137$3524148+10.4%
Maryland$135$34049285+8.4%
Washington$133$39446656+7.0%
California$132$3681612,057+6.2%
New Mexico$130$268655+4.9%
Florida$130$3882983,701+4.9%
Illinois$130$37462590+4.7%
Massachusetts$129$39240228+3.9%
Connecticut$128$35716191+3.4%
Colorado$128$39677485+3.2%
Oregon$128$39642378+3.1%
Utah$127$32029204+2.7%
Virginia$127$334691,112+2.3%
Vermont$126$431517+1.8%
West Virginia$126$38635134+1.5%
New Jersey$126$31641509+1.5%
Michigan$126$3271481,045+1.2%
Indiana$125$34653315+1.1%
Missouri$125$380811,323+0.9%
Alabama$125$33822247+0.8%
Georgia$125$35989854+0.7%
Hawaii$125$28211133+0.7%
Oklahoma$125$29543531+0.7%
South Dakota$124$2961664+0.0%
Wisconsin$124$52953309-0.1%
Arkansas$124$35117357-0.2%
Louisiana$124$31046388-0.3%
Puerto Rico$124$3038145-0.4%
Idaho$124$348223-0.4%
Ohio$123$5381161,138-0.6%
Pennsylvania$123$3572211,846-0.6%
Texas$123$3162383,353-0.7%
Kansas$123$683421-0.7%
Iowa$123$36920141-0.9%
Arizona$122$34028402-1.7%
Nebraska$121$28531128-2.6%
New York$121$3051248,662-2.6%
Minnesota$120$393117577-3.6%
South Carolina$119$43761783-3.8%
North Carolina$119$332951,329-4.1%
Kentucky$118$35512301-4.7%
Tennessee$117$327991,300-6.0%
Nevada$115$32513995-7.4%
Mississippi$109$3061257-12.2%

⚠️ 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