G0103

Prostate cancer screening; prostate specific antigen test (psa)

Code G0103. Medicare covered 1,406,946 of these. Here is what providers billed and what Medicare allowed, state by state.

$103.30Billed, national avg
$18.88Medicare allowed
5.5xBilled vs allowed
8.5xHighest vs lowest state

Providers in Wisconsin billed the most for this, at $164.17. In Virgin Islands the average was $19.29. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Wisconsin$164.17$18.868.7x25,112
Kansas$138.60$18.917.3x52,942
Alaska$136.75$18.887.2x1,614
Pennsylvania$135.73$18.897.2x24,737
Massachusetts$133.20$18.917.0x29,282
Georgia$130.59$18.896.9x50,955
Nevada$129.49$18.906.9x4,923
Illinois$129.21$18.896.8x40,292
New Jersey$123.81$18.876.6x100,139
California$119.77$18.916.3x90,448
Florida$114.11$18.886.0x117,579
Maryland$112.31$18.905.9x17,240
Texas$110.83$18.905.9x152,037
Colorado$108.69$18.915.7x17,503
North Carolina$102.91$18.905.4x133,473
Arizona$99.44$18.905.3x53,032
District of Columbia$97.53$18.925.2x320
West Virginia$97.43$18.855.2x1,077
Alabama$89.18$18.884.7x56,541
South Carolina$88.98$18.854.7x19,793
Minnesota$88.77$18.744.7x18,137
Ohio$88.29$18.884.7x75,935
Louisiana$86.09$18.874.6x11,509
Washington$85.80$18.904.5x25,230
Montana$84.57$18.894.5x2,470
South Dakota$82.32$18.864.4x4,670
Missouri$80.16$18.884.2x11,143
Wyoming$79.96$18.814.3x682
North Dakota$78.25$18.884.1x1,638
Oklahoma$76.72$18.904.1x19,199
Mississippi$75.99$18.834.0x9,311
New York$74.84$18.864.0x29,100
Kentucky$73.29$18.843.9x8,741
Oregon$70.09$18.873.7x17,036
Tennessee$69.75$18.873.7x66,157
Connecticut$68.37$18.913.6x1,989
New Mexico$67.78$18.853.6x2,721
Idaho$65.65$18.903.5x2,202
Virginia$60.88$18.913.2x37,124
Iowa$59.80$18.883.2x11,252
Indiana$59.69$18.823.2x15,520
Delaware$58.00$18.923.1x11
New Hampshire$54.96$18.922.9x898
Maine$54.67$18.912.9x2,252
Arkansas$54.66$18.852.9x9,870
Rhode Island$54.04$18.882.9x2,095
Utah$52.38$18.852.8x6,845
Michigan$51.82$18.802.8x10,820
Guam$50.19$18.922.7x14
Vermont$49.00$18.922.6x245
Nebraska$47.77$18.862.5x7,474
Hawaii$43.92$18.892.3x5,073
Puerto Rico$21.03$18.621.1x274
Virgin Islands$19.29$18.901.0x232

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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