67228

Destruction of leaking blood vessels of retina using laser

Medicare pricing data for 4,079 providers across 51 states

🤖AI Overview

This procedure has a 5.9x markup — hospitals charge $1,929 but Medicare allows only $325.36. Uninsured patients may face bills 5.9 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

Destruction of leaking blood vessels of retina using laser (HCPCS code 67228) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $325.36, but hospitals typically charge $1,929 — a 5.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$65.07

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $325.36, your out-of-pocket cost would be approximately $65.07. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$325.36
Average Hospital Charge
$1,929
Markup Ratio
5.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,928.54
Medicare Allowed$325.36
Medicare Payment$252.85

Hospitals charge 5.9x more than what Medicare allows for this procedure. Medicare actually pays $252.85 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$427$4,447518+31.2%
District of Columbia$376$1,8801080+15.5%
New York$373$2,1253073,360+14.7%
Connecticut$365$1,84039415+12.1%
California$355$1,8344855,466+9.1%
New Jersey$354$1,925104870+8.8%
Maryland$351$1,7721071,150+7.9%
Hawaii$349$2,32422165+7.2%
Massachusetts$337$2,227137808+3.7%
Delaware$337$782653+3.7%
Florida$336$1,6862542,142+3.3%
New Hampshire$335$2,068963+3.1%
Nevada$335$2,18024282+2.8%
Puerto Rico$334$3932282+2.8%
Montana$334$592414+2.7%
Rhode Island$334$1,64014118+2.6%
North Dakota$332$1,925671+2.1%
Illinois$328$2,1111942,398+0.7%
New Mexico$325$1,35715250-0.2%
Arizona$320$1,26059512-1.6%
Minnesota$318$1,85665366-2.2%
Michigan$317$1,3321591,444-2.6%
Virginia$316$1,81684999-2.8%
Vermont$314$2,756541-3.6%
Oregon$313$1,37954288-3.7%
Georgia$313$1,94784711-3.8%
Louisiana$312$1,70882790-4.1%
North Carolina$311$1,8411011,061-4.5%
South Carolina$311$1,62048458-4.5%
Oklahoma$310$1,81635718-4.7%
Pennsylvania$309$2,1771841,429-5.0%
Iowa$309$2,04847333-5.1%
Washington$309$1,39785656-5.1%
Wisconsin$308$3,18072600-5.3%
Colorado$306$1,71267434-6.0%
Ohio$302$1,9201511,210-7.1%
Alabama$301$1,46053527-7.5%
Texas$301$2,6403103,467-7.6%
Indiana$300$1,419771,143-7.9%
Missouri$300$1,98887636-7.9%
Kansas$299$1,58037425-8.0%
Utah$298$2,09641101-8.4%
Idaho$296$98814120-9.1%
Kentucky$295$1,74052480-9.4%
Tennessee$292$2,31174566-10.2%
Arkansas$291$1,88437472-10.7%
South Dakota$288$1,2731175-11.6%
Mississippi$287$1,93830256-11.7%
Maine$277$1,18521143-15.0%
West Virginia$262$2,19118270-19.4%
Nebraska$257$1,29824273-21.0%

⚠️ 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