Imaging · 76080
Review By Radiologist Of Abscess Or Sinus Cavity Study
What Medicare pays for 76080, what providers bill, and how the price varies across 47 states, drawn from CMS 2023 claims data.
- $20.06
- Medicare pays
- $135.22
- Providers bill
- 6.7×
- Markup
- #2,431 of 9,297
- Volume rank
The verdict
Review By Radiologist Of Abscess Or Sinus Cavity Study pairs above-median national service volume with an above-median markup.
- Top 26%
- national service volume
- Top 37%
- billed-to-Medicare markup
- 6.7×
- billed vs. Medicare
- $20.06
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
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). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Imaging, the applied ratio is 2.1x Medicare (RAND 2024 Radiology bucket (2.1x) + CMS Medicare baseline). 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
7 Among the most affordable more affordable than 63% of 8,901 procedures
Each bar is a 1-wide 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
What the billed charge breaks down into
$135.22
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Massachusetts | $24.11 | $120.77 |
| New York | $23.19 | $146.82 |
| California | $21.76 | $122.83 |
| District of Columbia | $21.41 | $115.81 |
| Florida | $20.75 | $230.44 |
| Maryland | $20.72 | $101.66 |
| New Jersey | $20.46 | $140.55 |
| Connecticut | $20.37 | $105.30 |
| Illinois | $20.36 | $142.75 |
| North Carolina | $20.32 | $127.09 |
| Delaware | $20.28 | $91.48 |
| Virginia | $20.05 | $95.25 |
| Montana | $19.91 | $94.77 |
| Oregon | $19.86 | $85.66 |
| Pennsylvania | $19.82 | $110.26 |
| Colorado | $19.74 | $109.01 |
| Rhode Island | $19.59 | $82.97 |
| Washington | $19.48 | $122.38 |
| Texas | $19.36 | $157.01 |
| Nevada | $19.23 | $179.74 |
| South Carolina | $19.23 | $127.78 |
| Michigan | $19.21 | $98.20 |
| Georgia | $19.10 | $111.25 |
| Minnesota | $19.09 | $159.14 |
| South Dakota | $19.01 | $98.58 |
| Kansas | $19.00 | $70.15 |
| Arizona | $18.98 | $194.20 |
| Ohio | $18.96 | $138.96 |
| Oklahoma | $18.83 | $61.84 |
| Iowa | $18.63 | $93.43 |
| Louisiana | $18.60 | $94.03 |
| Missouri | $18.57 | $141.27 |
| Indiana | $18.55 | $109.28 |
| Idaho | $18.54 | $93.23 |
| New Hampshire | $18.54 | $288.72 |
| Utah | $18.50 | $80.49 |
| North Dakota | $18.48 | $85.77 |
| Vermont | $18.44 | $141.53 |
| Wisconsin | $18.41 | $221.99 |
| West Virginia | $18.40 | $97.50 |
| Kentucky | $18.38 | $80.56 |
| New Mexico | $18.32 | $93.80 |
| Mississippi | $18.18 | $111.88 |
| Tennessee | $18.08 | $108.73 |
| Alabama | $18.02 | $101.83 |
| Nebraska | $17.70 | $87.16 |
| Arkansas | $17.16 | $261.10 |
What the Data Says About Review By Radiologist Of Abscess Or Sinus Cavity Study
Across 47 states with reporting providers, CPT code 76080 (Review By Radiologist Of Abscess Or Sinus Cavity Study) shows a national average Medicare payment of $20.06 against an average billed charge of $135.22. That gap, a 6.7x markup, or 574% above the Medicare allowed amount, is roughly in line with what most procedures show, chargemaster pricing that no major payer pays in full but that still anchors negotiations.
Imaging procedures like this one saw 14.5K services billed to Medicare in 2023 by 3.3K distinct providers, serving 8.5K unique beneficiaries. State-level variation is significant: Arkansas reports the lowest average payment at $17.16, while Massachusetts reports the highest at $24.11. The 40% 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 the RAND 2024 commercial-to-Medicare ratio for this category (2.1x Medicare; RAND 2024 Radiology bucket (2.1x) + CMS Medicare baseline), the estimated commercial insurance price lands near $53.49, with self-pay cash discounts commonly bringing the figure closer to $56.29. Within Imaging, Review By Radiologist Of Abscess Or Sinus Cavity Study ranks #116 of 133 tracked procedures by national average Medicare payment.
Where this sits in the registry
Review By Radiologist Of Abscess Or Sinus Cavity Study (76080) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Imaging codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Review By Radiologist Of Abscess Or Sinus Cavity Study rank among Medicare procedures?
According to CMS Medicare Part B claims, Review By Radiologist Of Abscess Or Sinus Cavity Study (CPT 76080) ranks #2,431 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #116 of 133 within Imaging by national average Medicare payment. See /methodology#corpus-placement.
How much does Review By Radiologist Of Abscess Or Sinus Cavity Study cost?
Medicare's national average payment for Review By Radiologist Of Abscess Or Sinus Cavity Study (CPT 76080) is $20.06, with providers billing $135.22 on average; state rates run from $17.16 to $24.11, 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 Review By Radiologist Of Abscess Or Sinus Cavity Study cost with insurance?
With commercial insurance, review by radiologist of abscess or sinus cavity study costs an estimated $53.49 on average (range: $37.44-$74.89), a moderate premium over Medicare's $20.06. Without insurance, the estimated cash price is $56.29.
Which state has the lowest cost for Review By Radiologist Of Abscess Or Sinus Cavity Study?
Arkansas has the lowest average Medicare payment for Review By Radiologist Of Abscess Or Sinus Cavity Study at $17.16, while Massachusetts has the highest at $24.11 - a meaningful $6.94 spread.
How many providers perform Review By Radiologist Of Abscess Or Sinus Cavity Study?
A moderate provider base performs Review By Radiologist Of Abscess Or Sinus Cavity Study: 3.3K providers nationally, totaling 14.5K Medicare-billed services (8.5K beneficiaries) across 47 states in 2023.
What is the billed-to-Medicare markup for Review By Radiologist Of Abscess Or Sinus Cavity Study?
Providers bill 6.7x what Medicare pays for Review By Radiologist Of Abscess Or Sinus Cavity Study - an above-median markup at 574% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (14.5K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($20.06 here).
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, the data changelog, or report a data error.