19303

Simple complete removal of breast

Medicare pricing data for 5,761 providers across 52 states

🤖AI Overview

Prices vary significantly by location — from $579 in Rhode Island to $1,178 in District of Columbia. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Simple complete removal of breast (HCPCS code 19303) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $945.79, but hospitals typically charge $3,718 — a 3.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$189.16

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $945.79, your out-of-pocket cost would be approximately $189.16. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$945.79
Average Hospital Charge
$3,718
Markup Ratio
3.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$3,717.72
Medicare Allowed$945.79
Medicare Payment$752.76

Hospitals charge 3.9x more than what Medicare allows for this procedure. Medicare actually pays $752.76 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$1,178$3,7521198+24.6%
Alaska$1,129$7,7462353+19.4%
Virginia$1,077$3,045120692+13.9%
New Jersey$1,072$4,519126508+13.3%
Indiana$1,036$4,671129513+9.6%
California$1,035$4,1625101,844+9.4%
Illinois$1,023$4,521221868+8.1%
Maryland$1,021$3,390109616+8.0%
Tennessee$1,000$3,573131553+5.7%
Nevada$995$3,68931128+5.2%
New York$992$5,8243521,173+4.9%
Vermont$992$4,3111654+4.8%
Hawaii$991$2,4391850+4.7%
Oklahoma$985$2,96542255+4.2%
Michigan$975$3,080167480+3.1%
Ohio$967$3,240218747+2.3%
Missouri$967$3,208105544+2.2%
North Carolina$958$3,257176745+1.3%
Pennsylvania$956$3,327236805+1.1%
Texas$955$4,2523761,540+1.0%
Florida$944$3,3144051,709-0.2%
New Hampshire$943$5,93934118-0.3%
Georgia$938$3,637162619-0.8%
Massachusetts$937$3,841129500-1.0%
Arkansas$933$3,09543298-1.4%
Colorado$931$3,290108406-1.6%
South Carolina$931$3,14287377-1.6%
Puerto Rico$925$1,235611-2.2%
Arizona$916$3,33696502-3.1%
Connecticut$901$3,55087225-4.7%
Oregon$898$3,161101329-5.0%
Iowa$895$3,42487317-5.4%
North Dakota$884$3,4222387-6.5%
Washington$884$3,214160571-6.5%
Kentucky$877$2,49483276-7.3%
Alabama$866$2,32492273-8.4%
Louisiana$864$2,83385351-8.7%
Montana$863$3,21834103-8.8%
Mississippi$862$2,33480286-8.8%
Wyoming$861$3,765818-9.0%
Wisconsin$828$7,465136381-12.5%
Kansas$794$2,75878356-16.0%
West Virginia$788$2,77550112-16.7%
New Mexico$784$3,1362190-17.1%
Minnesota$777$4,716150412-17.9%
Delaware$753$2,2112891-20.4%
Utah$717$2,04959185-24.2%
Nebraska$688$2,68354152-27.2%
South Dakota$648$2,72625141-31.4%
Idaho$635$1,87542171-32.9%
Maine$625$2,07326122-33.9%
Rhode Island$579$2,1441963-38.8%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber