G0296

Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)

Medicare pricing data for 11,912 providers across 49 states

🤖AI Overview

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

Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) (HCPCS code G0296) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $25.65, but hospitals typically charge $93.53 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.13

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $25.65, your out-of-pocket cost would be approximately $5.13. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$25.65
Average Hospital Charge
$93.53
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$93.53
Medicare Allowed$25.65
Medicare Payment$25.65

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $25.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$34$16757166+31.1%
New Jersey$29$771821,086+12.5%
Rhode Island$29$60926+11.7%
Vermont$28$80340+10.5%
New York$28$1157975,450+9.9%
Maryland$28$671401,493+9.1%
Massachusetts$28$886942,859+8.5%
Connecticut$28$8669337+8.3%
Illinois$27$1034661,851+5.3%
Florida$27$805063,372+4.4%
Georgia$27$793961,924+3.5%
Washington$26$853561,195+3.3%
Wyoming$26$141621+2.7%
Utah$26$701024+1.3%
Louisiana$26$6493377+0.9%
Virginia$26$756713,523+0.9%
Nevada$26$9129292+0.9%
Pennsylvania$26$654562,725+0.6%
Alabama$26$53141545+0.4%
New Hampshire$26$76234705-0.2%
Iowa$25$112127409-0.6%
Texas$25$803361,269-0.6%
Missouri$25$66218901-1.1%
North Carolina$25$986503,281-1.1%
Kentucky$25$743741,846-1.5%
Minnesota$25$906501,560-1.6%
Arizona$25$1452211,186-2.0%
District of Columbia$25$638167-2.5%
South Dakota$25$3891432-3.0%
Colorado$25$8583449-3.2%
South Carolina$25$944283,019-3.3%
Nebraska$25$84103351-3.3%
Michigan$25$702261,474-4.2%
Oregon$24$81110552-4.8%
Tennessee$24$1043372,328-5.4%
Indiana$24$722961,704-5.5%
Wisconsin$24$1864701,664-5.6%
West Virginia$24$9975257-6.0%
Ohio$24$1457864,488-6.1%
California$24$941931,432-6.8%
Mississippi$24$1031821,412-7.1%
Oklahoma$24$6864692-7.1%
Arkansas$24$6873336-8.0%
Idaho$24$57158339-8.1%
Kansas$23$7181768-8.8%
Montana$23$6947260-9.4%
Delaware$23$8235889-9.4%
North Dakota$23$5491411-11.5%
Maine$22$6464419-15.0%

⚠️ 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