G0476

Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test

Medicare pricing data for 513 providers across 39 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

Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test (HCPCS code G0476) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $34.37, but hospitals typically charge $111.33 — a 3.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.87

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $34.37, your out-of-pocket cost would be approximately $6.87. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$34.37
Average Hospital Charge
$111.33
Markup Ratio
3.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$111.33
Medicare Allowed$34.37
Medicare Payment$34.37

Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $34.37 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$34$120231+0.1%
Georgia$34$128292+0.1%
Idaho$34$68218+0.1%
Illinois$34$1367165+0.1%
Indiana$34$102267+0.1%
Iowa$34$115287+0.1%
Kansas$34$11311255+0.1%
Kentucky$34$99242+0.1%
Maine$34$56192+0.1%
Maryland$34$131354+0.1%
Massachusetts$34$1342123+0.1%
Minnesota$34$139139276+0.1%
Mississippi$34$106219+0.1%
Missouri$34$93831+0.1%
Nevada$34$825224+0.1%
New Hampshire$34$56183+0.1%
New Jersey$34$1373481+0.1%
New York$34$10910250+0.1%
North Carolina$34$1218645+0.1%
North Dakota$34$140364+0.1%
Oklahoma$34$90124+0.1%
Oregon$34$9852179+0.1%
Pennsylvania$34$1245164+0.1%
South Dakota$34$99390+0.1%
Tennessee$34$112341,458+0.1%
Texas$34$8215353+0.1%
Virginia$34$124255+0.1%
Washington$34$8913356+0.1%
West Virginia$34$1471376+0.1%
Wisconsin$34$185742+0.1%
Puerto Rico$34$35215+0.1%
Arkansas$34$54199+0.1%
Colorado$34$164697+0.1%
California$34$108822,800+0.0%
Florida$34$108381,9030.0%
Connecticut$34$944729-0.1%
Arizona$34$1514395-0.2%
Ohio$34$877269-0.3%
Alabama$34$1327257-0.6%

⚠️ 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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