A9595

Piflufolastat f-18, diagnostic, 1 millicurie

Medicare pricing data for 1,691 providers across 44 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

Piflufolastat f-18, diagnostic, 1 millicurie (HCPCS code A9595) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $625.60, but hospitals typically charge $1,244 — a 2.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$125.12

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $625.60, your out-of-pocket cost would be approximately $125.12. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$625.60
Average Hospital Charge
$1,244
Markup Ratio
2.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,243.93
Medicare Allowed$625.60
Medicare Payment$498.42

Hospitals charge 2.0x more than what Medicare allows for this procedure. Medicare actually pays $498.42 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Mexico$897$1,897121,928+43.4%
Texas$766$1,66628413,936+22.5%
New Jersey$762$1,209626,156+21.8%
Louisiana$700$1,819151,457+11.9%
Virginia$692$1,028307,570+10.7%
Arkansas$687$2,346392,175+9.7%
District of Columbia$673$1,0683193+7.5%
Mississippi$672$2,2688623+7.5%
Colorado$661$1,932456,784+5.6%
Maryland$649$7606213,248+3.8%
Oklahoma$635$2,622121,362+1.4%
Missouri$619$1,23613802-1.0%
Massachusetts$619$7292611,194-1.1%
South Dakota$614$7124366-1.8%
Utah$614$1,51912659-1.8%
Oregon$614$1,008241,523-1.9%
Maine$613$6973551-2.0%
Rhode Island$609$1,1201425-2.6%
Minnesota$609$1,223533,885-2.7%
Arizona$608$1,2057610,979-2.8%
California$608$1,15626142,385-2.8%
Nevada$608$1,348191,607-2.9%
Kansas$608$70273,078-2.9%
Washington$607$1,247274,777-3.0%
Connecticut$606$1,0113784-3.1%
Wisconsin$605$1,026171,881-3.3%
Pennsylvania$605$878465,456-3.3%
Kentucky$604$8042177-3.4%
Illinois$601$1,172828,539-3.9%
North Carolina$598$1,339283,405-4.4%
Delaware$598$6931146-4.4%
Idaho$597$1,1664218-4.6%
New Hampshire$594$6313963-5.1%
Tennessee$591$1,248103,695-5.5%
New York$590$1,60412827,956-5.7%
Michigan$588$7505533-5.9%
Montana$583$1,3801234-6.8%
Alabama$582$702292,641-7.0%
South Carolina$582$1,086224,260-7.0%
Indiana$581$841242,285-7.2%
Florida$579$1,10812919,581-7.4%
Nebraska$549$896494-12.3%
Ohio$544$2,137393,305-13.1%
Georgia$517$7989965-17.3%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber