68840

Probing of nasal tear duct

Medicare pricing data for 3,282 providers across 50 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

Probing of nasal tear duct (HCPCS code 68840) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $162.00, but hospitals typically charge $445.49 — a 2.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$32.40

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $162.00, your out-of-pocket cost would be approximately $32.40. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$162.00
Average Hospital Charge
$445.49
Markup Ratio
2.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$445.49
Medicare Allowed$162.00
Medicare Payment$123.11

Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $123.11 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Hawaii$206$40915327+27.1%
New York$195$4762032,125+20.7%
District of Columbia$192$4839114+18.7%
New Jersey$183$4251261,685+12.7%
California$181$4804204,870+11.4%
Puerto Rico$178$230813+10.1%
Connecticut$176$46942307+8.5%
Alaska$175$642822+8.3%
Delaware$172$453657+6.1%
Maryland$171$40254420+5.5%
Texas$169$4032352,871+4.6%
North Dakota$167$4401254+2.9%
Oregon$166$50745325+2.4%
South Dakota$163$43313173+0.4%
Illinois$160$4271011,253-1.2%
Washington$160$41897817-1.5%
Pennsylvania$160$382137639-1.5%
Minnesota$160$57440334-1.5%
Michigan$158$399115794-2.3%
North Carolina$158$40795904-2.7%
Massachusetts$157$56767662-3.1%
Florida$156$4112612,480-3.4%
Kentucky$154$32835193-4.7%
Colorado$154$48381560-4.9%
Rhode Island$153$443979-5.5%
Vermont$152$300664-5.9%
Arizona$151$36163442-6.8%
Georgia$150$50789746-7.4%
Kansas$149$34829297-7.9%
Montana$149$308412-8.1%
West Virginia$147$4031853-9.3%
Virginia$146$42480651-9.6%
New Hampshire$146$45114122-10.2%
Missouri$146$38548341-10.2%
Indiana$145$30850312-10.4%
Idaho$145$36222132-10.5%
Utah$143$35652170-11.8%
South Carolina$142$47755429-12.2%
Tennessee$142$40771571-12.4%
Oklahoma$142$39129274-12.5%
Ohio$140$54496832-13.7%
Alabama$139$22338118-14.4%
Iowa$136$47732176-15.9%
Arkansas$135$34423164-16.9%
Maine$134$4421256-17.5%
Nebraska$132$30916109-18.2%
Mississippi$126$25826129-22.1%
Wisconsin$121$72848220-25.3%
Louisiana$105$57344327-35.3%
Nevada$104$507221,016-35.6%

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

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💊 Need post-procedure medications? Check costs on OpenPrescriber