Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries
What Medicare pays for A9520, what providers bill, and how the price varies across 12 states, drawn from CMS 2023 claims data.
A9520 · the short answer
For technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries, Medicare pays about $478.46 while providers bill $1,199.63 on average, a 2.5× markup, one of the smaller markups in the catalog. State-level Medicare rates range 1486% from lowest to highest.
- Medicare pays
- $478.46
- Providers bill
- $1,199.63
- Markup
- 2.5×
- Markup percentile
- 9th
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: Medical Supplies 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
3 more affordable than 9% 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 |
|---|---|---|
| New York | $661.63 | $1,030.06 |
| Illinois | $516.20 | $1,097.65 |
| Arkansas | $512.43 | $1,691.92 |
| Florida | $504.96 | $2,524.57 |
| Washington | $499.10 | $1,103.18 |
| California | $490.33 | $854.49 |
| Oregon | $486.55 | $856.56 |
| New Jersey | $484.99 | $687.88 |
| Tennessee | $467.85 | $1,489.50 |
| Nebraska | $422.55 | $791.97 |
| Kansas | $54.88 | $70.00 |
| Ohio | $41.71 | $935.82 |
What the Data Says About Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries
Across 12 states with reporting providers, CPT code A9520 (Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries) shows a national average Medicare payment of $478.46 against an average billed charge of $1,199.63. That gap, a 2.5x markup, or 151% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Medical Supplies procedures like this one saw 885 services billed to Medicare in 2023 by 162 distinct providers, serving 878 unique beneficiaries. State-level variation is significant: Ohio reports the lowest average payment at $41.71, while New York reports the highest at $661.63. A 1486% 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 Medical Supplies category (2.24x), the estimated commercial insurance price lands near $1,345.66, with self-pay cash discounts commonly bringing the figure closer to $780.45. Within Medical Supplies, Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries ranks #24 of 84 tracked procedures by national average Medicare payment.
What to do with this
If you may have technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries 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 technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries 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 Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries cost?
Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries (CPT A9520) shows unusually wide state-to-state pricing: Medicare pays $478.46 on average nationally, but the $41.71-$661.63 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 Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries cost with insurance?
With commercial insurance, technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries costs an estimated $1,345.66 on average (range: $941.96-$1,883.93), a moderate premium over Medicare's $478.46. Without insurance, the estimated cash price is $780.45.
Which state has the lowest cost for Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries?
Ohio has by far the lowest average Medicare payment for Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries at $41.71, while New York pays more than double at $661.63 - a $619.92 gap.
How many providers perform Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries?
Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries is comparatively uncommon: only 162 providers nationally billed Medicare for it in 2023, serving 878 beneficiaries via 885 total services.
What is the billed-to-Medicare markup for Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries?
Providers bill 2.5x what Medicare pays for Technetium Tc-99m Tilmanocept, Diagnostic, Up To 0.5 Millicuries - one of the smaller markups in the catalog at 151% 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.