G0452

Molecular pathology procedure; physician interpretation and report

Medicare pricing data for 1,506 providers across 40 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

Molecular pathology procedure; physician interpretation and report (HCPCS code G0452) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $47.22, but hospitals typically charge $143.83 — a 3.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$9.44

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $47.22, your out-of-pocket cost would be approximately $9.44. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$47.22
Average Hospital Charge
$143.83
Markup Ratio
3.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$143.83
Medicare Allowed$47.22
Medicare Payment$36.63

Hospitals charge 3.0x more than what Medicare allows for this procedure. Medicare actually pays $36.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$51$17715521,322+7.8%
New Jersey$50$210557,035+5.1%
Massachusetts$49$180959,801+4.6%
Connecticut$49$110222,753+4.2%
California$49$1227712,165+4.2%
Maryland$49$92131,897+2.9%
District of Columbia$48$1126587+2.1%
Rhode Island$48$954436+1.8%
Oregon$48$198291,747+1.4%
Hawaii$47$754213+0.4%
Louisiana$47$70436+0.1%
Colorado$47$16111734-0.3%
Texas$47$21814425,051-0.6%
Missouri$47$137222,229-0.6%
Pennsylvania$47$15312210,104-0.7%
Utah$47$10715306-1.3%
Illinois$46$91747,150-2.5%
Florida$46$77826,192-2.6%
Georgia$46$12316374-2.9%
Oklahoma$46$88561-3.1%
Minnesota$46$123862,309-3.6%
Maine$45$5026276-3.7%
Arizona$45$501212,445-3.8%
Michigan$45$115735,059-3.9%
Ohio$45$116572,534-4.0%
Virginia$45$93191,818-4.1%
New Mexico$45$1318774-5.7%
South Carolina$44$17961,377-5.9%
North Carolina$44$125275,179-6.4%
Mississippi$44$984215-6.5%
Tennessee$44$104807,861-6.6%
Kansas$44$1132209-6.7%
Alabama$44$8813567-7.0%
Arkansas$44$9681,385-7.4%
Iowa$44$127151,376-7.4%
Wisconsin$43$8516181-8.2%
Indiana$41$4925774-13.0%
Nebraska$41$415367-13.5%
Washington$36$6253553-24.2%
Kentucky$31$325307-33.8%

⚠️ 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

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