Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent
What Medicare pays for 68815, what providers bill, and how the price varies across 42 states, drawn from CMS 2023 claims data.
68815 · the short answer
For probing of nasal tear duct with insertion of tube or stent, Medicare pays about $274.39 while providers bill $2,431.74 on average, a 8.9× markup, a higher-than-typical markup. State-level Medicare rates range 236% from lowest to highest.
- Medicare pays
- $274.39
- Providers bill
- $2,431.74
- Markup
- 8.9×
- Markup percentile
- 82th
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
9 Among the most affordable more affordable than 82% 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 |
|---|---|---|
| Delaware | $364.57 | $2,467.70 |
| New Jersey | $341.68 | $2,764.06 |
| California | $320.93 | $2,986.89 |
| Indiana | $320.36 | $3,188.77 |
| New York | $319.14 | $1,887.93 |
| Washington | $305.14 | $1,157.09 |
| Maryland | $303.53 | $2,519.64 |
| Nevada | $298.02 | $3,441.33 |
| Kansas | $294.53 | $4,585.56 |
| Idaho | $294.08 | $1,389.37 |
| Florida | $291.01 | $3,147.64 |
| Virginia | $289.72 | $2,356.53 |
| Colorado | $287.83 | $2,520.88 |
| Arizona | $286.53 | $1,936.23 |
| Mississippi | $280.68 | $1,812.04 |
| Utah | $280.42 | $3,594.22 |
| Minnesota | $267.25 | $2,454.84 |
| Illinois | $267.18 | $2,753.53 |
| Texas | $263.51 | $3,304.53 |
| Connecticut | $261.45 | $3,609.99 |
| Ohio | $257.92 | $2,017.39 |
| Pennsylvania | $254.70 | $2,000.98 |
| Tennessee | $254.35 | $1,977.30 |
| Oklahoma | $253.62 | $1,697.62 |
| Hawaii | $248.22 | $1,415.04 |
| Massachusetts | $245.96 | $1,895.32 |
| Oregon | $240.30 | $3,320.97 |
| Michigan | $237.28 | $1,537.24 |
| Kentucky | $229.87 | $1,835.06 |
| Georgia | $227.12 | $2,011.38 |
| North Carolina | $225.79 | $1,578.31 |
| New Hampshire | $222.32 | $1,984.71 |
| Nebraska | $222.22 | $1,606.51 |
| Arkansas | $220.91 | $911.58 |
| Louisiana | $217.20 | $2,207.04 |
| Iowa | $215.98 | $1,831.87 |
| South Carolina | $208.24 | $1,858.14 |
| South Dakota | $201.89 | $1,269.71 |
| Alabama | $198.88 | $1,464.03 |
| Missouri | $163.18 | $1,488.74 |
| Wisconsin | $155.56 | $2,896.85 |
| West Virginia | $108.43 | $828.60 |
What the Data Says About Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent
Across 42 states with reporting providers, CPT code 68815 (Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent) shows a national average Medicare payment of $274.39 against an average billed charge of $2,431.74. That gap, a 8.9x markup, or 786% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.
Eye Surgery procedures like this one saw 9.4K services billed to Medicare in 2023 by 1.6K distinct providers, serving 5.7K unique beneficiaries. State-level variation is significant: West Virginia reports the lowest average payment at $108.43, while Delaware reports the highest at $364.57. A 236% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Eye Surgery category (2.24x), the estimated commercial insurance price lands near $773.75, with self-pay cash discounts commonly bringing the figure closer to $927.79. Within Eye Surgery, Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent ranks #180 of 266 tracked procedures by national average Medicare payment.
What to do with this
If you may have probing of nasal tear duct with insertion of tube or stent 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 probing of nasal tear duct with insertion of tube or stent 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 Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent cost?
Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent (CPT 68815) shows unusually wide state-to-state pricing: Medicare pays $274.39 on average nationally, but the $108.43-$364.57 range across states spans more than double from cheapest to priciest.
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 Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent cost with insurance?
With commercial insurance, probing of nasal tear duct with insertion of tube or stent costs an estimated $773.75 on average (range: $541.62-$1,083.24), a moderate premium over Medicare's $274.39. Without insurance, the estimated cash price is $927.79.
Which state has the lowest cost for Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent?
West Virginia has by far the lowest average Medicare payment for Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent at $108.43, while Delaware pays more than double at $364.57 - a $256.14 gap.
How many providers perform Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent?
A moderate provider base performs Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent: 1.6K providers nationally, totaling 9.4K Medicare-billed services (5.7K beneficiaries) across 42 states in 2023.
What is the billed-to-Medicare markup for Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent?
Providers bill 8.9x what Medicare pays for Probing Of Nasal Tear Duct With Insertion Of Tube Or Stent - a higher-than-typical markup at 786% 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.