Removal Of Tear Sac
What Medicare pays for 68520, what providers bill, and how the price varies across 3 states, drawn from CMS 2023 claims data.
68520 · the short answer
For removal of tear sac, Medicare pays about $591.43 while providers bill $2,927.60 on average, a 5.0× markup, a below-median markup. State-level Medicare rates range 48% from lowest to highest.
- Medicare pays
- $591.43
- Providers bill
- $2,927.60
- Markup
- 5.0×
- Markup percentile
- 30th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
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: Eye 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.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
5 more affordable than 30% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Florida | $560.69 | $2,902.97 |
| South Carolina | $439.26 | $2,275.65 |
| Washington | $378.81 | $1,339.44 |
What the Data Says About Removal Of Tear Sac
Across 3 states with reporting providers, CPT code 68520 (Removal Of Tear Sac) shows a national average Medicare payment of $591.43 against an average billed charge of $2,927.60. That gap, a 5.0x markup, or 395% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Eye Surgery procedures like this one saw 161 services billed to Medicare in 2023 by 104 distinct providers, serving 119 unique beneficiaries. State-level variation is significant: Washington reports the lowest average payment at $378.81, while Florida reports the highest at $560.69. The 48% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Eye Surgery category (2.24x), the estimated commercial insurance price lands near $1,668.90, with self-pay cash discounts commonly bringing the figure closer to $1,363.87. Within Eye Surgery, Removal Of Tear Sac ranks #86 of 266 tracked procedures by national average Medicare payment.
What to do with this
If you may have removal of tear sac done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare removal of tear sac costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Removal Of Tear Sac cost?
Medicare's national average payment for Removal Of Tear Sac (CPT 68520) is $591.43, with providers billing $2,927.60 on average; state rates run from $378.81 to $560.69, a meaningful but not extreme spread.
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 Removal Of Tear Sac cost with insurance?
With commercial insurance, removal of tear sac costs an estimated $1,668.90 on average (range: $1,168.23-$2,336.47), a moderate premium over Medicare's $591.43. Without insurance, the estimated cash price is $1,363.87.
Which state has the lowest cost for Removal Of Tear Sac?
Washington has the lowest average Medicare payment for Removal Of Tear Sac at $378.81, while Florida has the highest at $560.69 - a meaningful $181.88 spread.
How many providers perform Removal Of Tear Sac?
Removal Of Tear Sac is comparatively uncommon: only 104 providers nationally billed Medicare for it in 2023, serving 119 beneficiaries via 161 total services.
What is the billed-to-Medicare markup for Removal Of Tear Sac?
Providers bill 5.0x what Medicare pays for Removal Of Tear Sac - a below-median markup at 395% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.