Urinary Surgery · 50684

Injection Of Ureter For Imaging

Medicare Payment (avg)
$29.12
What Medicare actually pays
Billed Charge (avg)
$638.33
What providers submit
Markup
21.9x
2092% above Medicare rate
583
Total Services
504
Beneficiaries
133
Providers
11
States with Data

Price Range Across States

Lowest State Avg
$19.11
Georgia
Highest State Avg
$53.00
New York

What You Might Pay

Est. Commercial Insurance
$82.45
Range: $57.72 – $115.43
Est. Cash / Self-Pay
$203.15
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Urinary Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
New York $53.00 $2,104.47
Pennsylvania $35.65 $370.41
North Carolina $35.24 $212.41
Maryland $28.66 $435.04
South Carolina $24.36 $235.69
Oklahoma $23.56 $119.48
California $23.27 $616.15
Florida $23.22 $95.07
Illinois $22.97 $748.67
Connecticut $21.36 $1,172.00
Georgia $19.11 $298.33

What the Data Says About Injection Of Ureter For Imaging

Across 11 states with reporting providers, CPT code 50684 (Injection Of Ureter For Imaging) shows a national average Medicare payment of $29.12 against an average billed charge of $638.33. That gap — a 21.9x markup, or 2092% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Urinary Surgery procedures like this one saw 583 services billed to Medicare in 2023 by 133 distinct providers, serving 504 unique beneficiaries. State-level variation is significant: Georgia reports the lowest average payment at $19.11, while New York reports the highest at $53.00. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Urinary Surgery category (2.24x), the estimated commercial insurance price lands near $82.45, with self-pay cash discounts commonly bringing the figure closer to $203.15. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Injection Of Ureter For Imaging cost?

The national average Medicare payment for Injection Of Ureter For Imaging (CPT 50684) is $29.12, while providers typically bill $638.33. Prices vary significantly by state, ranging from $19.11 to $53.00.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Injection Of Ureter For Imaging cost with insurance?

With commercial insurance, Injection Of Ureter For Imaging costs an estimated $82.45 on average (range: $57.72 – $115.43). Without insurance, the estimated cash price is $203.15. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Injection Of Ureter For Imaging?

Georgia has the lowest average Medicare payment for Injection Of Ureter For Imaging at $19.11, while New York has the highest at $53.00. This $33.89 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Injection Of Ureter For Imaging?

Nationally, 133 providers billed Medicare for Injection Of Ureter For Imaging in 2023, performing 583 total services for 504 beneficiaries across 11 states and territories.

What is the billed-to-Medicare markup for Injection Of Ureter For Imaging?

Providers bill 21.9x what Medicare pays for Injection Of Ureter For Imaging — a 2092% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial