A4561

Pessary, rubber, any type

Medicare pricing data for 2,547 providers across 47 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Pessary, rubber, any type (HCPCS code A4561) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $26.29, but hospitals typically charge $81.76 — a 3.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.26

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $26.29, your out-of-pocket cost would be approximately $5.26. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$26.29
Average Hospital Charge
$81.76
Markup Ratio
3.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$81.76
Medicare Allowed$26.29
Medicare Payment$19.21

Hospitals charge 3.1x more than what Medicare allows for this procedure. Medicare actually pays $19.21 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Wyoming$27$1611232+3.2%
Utah$27$572557+2.9%
Alaska$27$961425+2.7%
Mississippi$27$611841+2.7%
Georgia$27$10667138+2.6%
New Mexico$27$932257+2.6%
North Dakota$27$38831+2.6%
Alabama$27$594587+2.6%
Tennessee$27$9159244+2.5%
Florida$27$76154381+2.2%
Montana$27$861012+2.1%
Wisconsin$27$6543149+2.1%
North Carolina$27$6790164+2.1%
Texas$27$80153373+2.0%
Ohio$27$69118303+1.8%
South Carolina$27$7654126+1.7%
Kansas$27$641733+1.6%
Illinois$27$8397220+1.5%
Nebraska$27$46913+1.5%
Arkansas$27$4830104+1.3%
Minnesota$27$8347119+1.1%
Oklahoma$27$663366+1.1%
Missouri$27$7646115+0.8%
Colorado$26$6538155+0.7%
Michigan$26$8163112+0.5%
Louisiana$26$772345+0.5%
Arizona$26$792539-0.3%
Kentucky$26$684980-0.4%
Iowa$26$702649-0.5%
Oregon$26$682682-0.5%
Pennsylvania$26$55134342-0.5%
Delaware$26$63415-0.7%
Indiana$26$5554114-0.9%
California$26$91280908-1.0%
Connecticut$26$6658111-1.3%
Massachusetts$26$7081246-1.4%
New York$26$118131344-1.7%
Nevada$26$10038129-2.1%
Virginia$26$72106285-2.2%
Idaho$26$542058-2.2%
Rhode Island$26$501022-2.2%
Maryland$26$6859164-2.3%
New Hampshire$26$681944-2.6%
Washington$26$652672-3.0%
New Jersey$25$17662237-5.6%
Maine$25$611117-6.1%
West Virginia$24$1101746-7.6%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber