67145

Photocoagulation treatment to prevent detachment of retina

Medicare pricing data for 4,081 providers across 52 states

🤖AI Overview

This procedure has a 5.8x markup — hospitals charge $1,359 but Medicare allows only $232.84. Uninsured patients may face bills 5.8 times higher than what insurance negotiates. 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

Photocoagulation treatment to prevent detachment of retina (HCPCS code 67145) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $232.84, but hospitals typically charge $1,359 — a 5.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$46.57

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $232.84, your out-of-pocket cost would be approximately $46.57. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$232.84
Average Hospital Charge
$1,359
Markup Ratio
5.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,359.32
Medicare Allowed$232.84
Medicare Payment$177.24

Hospitals charge 5.8x more than what Medicare allows for this procedure. Medicare actually pays $177.24 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$264$1,3654343,017+13.2%
Connecticut$260$1,87047309+11.5%
District of Columbia$258$1,200729+10.8%
Maryland$258$1,110106918+10.8%
New Jersey$255$1,530101641+9.5%
New York$255$1,6132851,897+9.4%
Delaware$244$559646+4.9%
New Hampshire$243$1,45914107+4.3%
Virginia$243$1,137951,092+4.2%
Rhode Island$242$9921472+4.1%
Wyoming$242$784214+3.9%
Montana$242$88415168+3.7%
Puerto Rico$240$5691347+3.2%
Nevada$238$1,29831312+2.3%
Illinois$238$1,3001761,416+2.0%
Massachusetts$237$1,441140958+1.6%
Minnesota$235$1,88772344+0.9%
Pennsylvania$233$1,7211841,484+0.1%
Florida$233$1,0692632,476+0.1%
Hawaii$232$1,26624103-0.3%
Arizona$231$1,04755666-0.7%
Utah$231$1,35032128-1.0%
Oregon$229$1,04571425-1.6%
Georgia$229$1,62972532-1.7%
Vermont$229$1,575861-1.8%
North Dakota$229$7131069-1.9%
New Mexico$228$87915131-2.0%
South Carolina$227$1,13349568-2.5%
Texas$226$1,4072982,340-2.9%
Colorado$225$1,00184845-3.2%
Michigan$224$1,297149798-3.7%
Missouri$224$1,40674414-3.8%
Oklahoma$223$1,18326526-4.1%
Wisconsin$223$3,07385590-4.1%
South Dakota$223$1,20012163-4.2%
North Carolina$223$1,192110865-4.3%
Kansas$223$1,77143425-4.4%
Louisiana$222$1,29567632-4.6%
Washington$221$1,16695784-5.2%
Iowa$217$1,24057394-6.9%
Kentucky$217$1,31546405-7.0%
Ohio$216$1,3901681,017-7.4%
Tennessee$215$1,43186615-7.6%
Idaho$209$1,14420158-10.4%
Indiana$207$1,37174645-11.2%
Mississippi$207$1,17435530-11.3%
Alabama$202$1,26158333-13.3%
Alaska$201$3,6251058-13.7%
Nebraska$198$99631349-15.1%
West Virginia$198$1,2861793-15.1%
Arkansas$196$1,14439268-15.7%
Maine$194$1,42530202-16.8%

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

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💊 Need post-procedure medications? Check costs on OpenPrescriber