74328

Review by radiologist of image from tube placement into bile duct using an endoscope

Medicare pricing data for 7,044 providers across 51 states

🤖AI Overview

This procedure has a 7.8x markup — hospitals charge $170.41 but Medicare allows only $21.82. Uninsured patients may face bills 7.8 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

Review by radiologist of image from tube placement into bile duct using an endoscope (HCPCS code 74328) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $21.82, but hospitals typically charge $170.41 — a 7.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.36

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $21.82, your out-of-pocket cost would be approximately $4.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$21.82
Average Hospital Charge
$170.41
Markup Ratio
7.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$170.41
Medicare Allowed$21.82
Medicare Payment$17.33

Hospitals charge 7.8x more than what Medicare allows for this procedure. Medicare actually pays $17.33 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$30$23230170+38.4%
New York$25$2112993,233+14.2%
California$24$2005595,776+12.1%
District of Columbia$24$11113400+10.9%
Connecticut$24$15393784+10.2%
Massachusetts$24$1381592,023+9.8%
Washington$24$1191791,636+7.8%
New Jersey$23$3411891,266+7.7%
Rhode Island$23$13254400+6.0%
Hawaii$23$20922186+5.7%
Montana$23$13932216+5.0%
Maryland$23$13871766+4.9%
Oregon$23$11888481+4.2%
Nevada$23$16259332+3.9%
New Hampshire$23$21348408+3.8%
Wyoming$23$98525+3.3%
North Dakota$23$10313275+3.3%
Maine$23$11235252+3.2%
Texas$22$1785334,213+2.6%
Vermont$22$1497113+2.5%
Missouri$22$1541661,576+2.4%
Minnesota$22$1341601,519+2.3%
Pennsylvania$22$1432872,527+2.1%
Illinois$22$2033863,026+1.9%
South Dakota$22$9019394+1.8%
Utah$22$11349311+0.5%
Michigan$22$1472041,517+0.4%
Kansas$22$10070467+0.2%
Colorado$22$1181711,433+0.1%
Indiana$22$1771441,560-0.6%
Louisiana$22$22999557-0.8%
Nebraska$22$13452232-1.2%
Iowa$22$14378507-1.3%
Arizona$21$1321451,444-2.0%
Mississippi$21$45952289-3.4%
Virginia$21$1411701,728-3.6%
Oklahoma$21$131100873-3.6%
Idaho$21$9653350-5.2%
Alabama$20$11777635-6.1%
North Carolina$20$1861811,915-6.6%
West Virginia$20$14454622-7.0%
New Mexico$20$16135142-7.7%
Delaware$20$971686-9.2%
Arkansas$20$13368345-9.8%
Wisconsin$19$2192241,225-11.1%
Ohio$19$1462371,837-11.6%
Georgia$19$1732541,218-14.1%
Florida$18$2035724,149-17.4%
Tennessee$18$1501731,162-18.6%
South Carolina$17$125121797-21.1%
Kentucky$16$115100666-27.3%

⚠️ 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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