78226

Nuclear medicine study of liver and bile duct system

Medicare pricing data for 9,380 providers across 51 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

Nuclear medicine study of liver and bile duct system (HCPCS code 78226) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $44.91, but hospitals typically charge $216.71 — a 4.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$8.98

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $44.91, your out-of-pocket cost would be approximately $8.98. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$44.91
Average Hospital Charge
$216.71
Markup Ratio
4.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$216.71
Medicare Allowed$44.91
Medicare Payment$34.69

Hospitals charge 4.8x more than what Medicare allows for this procedure. Medicare actually pays $34.69 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$64$2887844,629+41.5%
Maryland$54$187160794+21.0%
New York$54$2474152,653+20.8%
California$51$2318645,351+14.6%
Nevada$51$32092300+14.4%
Tennessee$50$2112731,380+12.3%
New Jersey$49$2183351,954+8.8%
Alaska$47$3181844+4.2%
Connecticut$47$193117595+3.6%
Nebraska$46$15968295+2.9%
Mississippi$46$205102582+1.8%
Illinois$44$2334662,136-2.6%
Arizona$43$362146797-4.1%
Ohio$42$2382521,243-5.4%
Texas$41$2516642,945-8.1%
Kentucky$41$166141558-8.8%
North Carolina$41$2023311,256-8.9%
Arkansas$39$15781392-12.3%
Pennsylvania$39$2224192,104-14.0%
Massachusetts$38$140226898-14.7%
District of Columbia$38$1621774-16.3%
Iowa$37$174100244-17.1%
Missouri$36$1542091,104-19.0%
South Carolina$36$201188578-19.3%
Delaware$35$16622195-21.9%
Washington$35$141112603-22.0%
Rhode Island$35$13722160-22.2%
New Hampshire$35$16464179-22.6%
Montana$35$1183363-22.9%
Minnesota$35$179234618-23.1%
Colorado$34$197126389-23.3%
Hawaii$34$23921121-23.4%
New Mexico$34$20243254-23.4%
Michigan$34$1972851,569-23.5%
Alabama$34$111184830-23.6%
Vermont$34$1992056-23.7%
Virginia$34$1332141,120-23.8%
Wyoming$34$1352054-23.8%
Oregon$34$135101282-23.9%
North Dakota$34$1232597-24.1%
Maine$34$1333158-24.2%
Georgia$34$1973341,250-24.6%
Utah$34$1583786-24.8%
Louisiana$34$211173604-24.8%
South Dakota$34$13316170-25.0%
Indiana$34$141196892-25.2%
Idaho$34$18741105-25.3%
Oklahoma$33$153116402-25.6%
Wisconsin$33$255186567-25.7%
Kansas$33$10891346-25.7%
West Virginia$33$16383329-26.3%

⚠️ 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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