Q9969

Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose

Medicare pricing data for 181 providers across 17 states

🤖AI Overview

Prices vary significantly by location — from $9 in New York to $50 in Illinois. 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

Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose (HCPCS code Q9969) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $14.40, but hospitals typically charge $35.49 — a 2.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.88

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $14.40, your out-of-pocket cost would be approximately $2.88. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$14.40
Average Hospital Charge
$35.49
Markup Ratio
2.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$35.49
Medicare Allowed$14.40
Medicare Payment$11.47

Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $11.47 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Illinois$50$775863+248.9%
Texas$20$2319484+39.2%
Massachusetts$15$155258+2.5%
California$13$38101,191-9.4%
Ohio$13$201162-12.2%
Mississippi$12$125277-19.1%
Georgia$10$393238-31.7%
Idaho$10$106250-31.7%
Louisiana$10$10654-31.7%
Arizona$10$5071,053-31.7%
Utah$10$10177-32.4%
Alabama$10$14181,356-32.4%
North Carolina$10$30221,723-32.5%
Washington$10$1023650-32.9%
Florida$10$11410600-33.6%
Virginia$10$1027634-33.9%
New York$9$14316-35.9%

⚠️ 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