G0279

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)

Code G0279. Medicare covered 1,000,625 of these. Here is what providers billed and what Medicare allowed, state by state.

$153.19Billed, national avg
$33.19Medicare allowed
4.6xBilled vs allowed
4.4xHighest vs lowest state

Providers in Colorado billed the most for this, at $235.73. In Guam the average was $53.30. 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
Colorado$235.73$36.856.4x13,493
Hawaii$229.67$37.066.2x2,768
Arizona$205.97$36.875.6x22,386
Arkansas$203.42$31.316.5x13,158
Rhode Island$202.77$34.995.8x6,120
New Jersey$195.60$40.154.9x35,340
Wisconsin$189.91$29.646.4x15,284
Texas$180.26$31.905.7x57,850
California$174.97$37.414.7x95,795
Massachusetts$173.74$30.525.7x33,499
Georgia$173.52$30.855.6x28,394
New York$172.89$37.014.7x61,559
Armed Forces Pacific$168.83$38.914.3x299
District of Columbia$166.91$36.954.5x9,548
Connecticut$163.19$33.924.8x10,258
Wyoming$162.78$35.494.6x1,523
Florida$162.40$37.414.3x85,484
Nevada$156.23$38.864.0x5,827
Washington$152.65$34.454.4x22,639
New Mexico$151.67$36.614.1x5,753
Iowa$150.23$29.515.1x9,972
Illinois$148.24$30.164.9x47,186
Nebraska$145.64$28.905.0x6,190
Virginia$144.40$32.024.5x35,530
North Carolina$143.47$33.444.3x38,920
Maryland$140.79$40.753.5x29,338
Minnesota$138.75$33.354.2x16,269
Tennessee$136.16$30.724.4x26,243
Alaska$129.94$27.594.7x1,511
South Carolina$128.07$29.144.4x15,929
Oklahoma$125.49$28.064.5x11,150
Michigan$124.67$29.454.2x21,682
Louisiana$122.71$28.284.3x11,346
Ohio$119.49$27.984.3x28,684
Maine$119.13$27.414.3x3,907
Mississippi$118.73$27.924.3x7,651
Missouri$116.12$28.044.1x21,649
Vermont$115.28$27.274.2x1,792
New Hampshire$114.44$30.993.7x4,409
Kentucky$112.93$29.113.9x11,664
Pennsylvania$112.86$29.273.9x49,065
Delaware$111.25$34.653.2x4,495
Utah$109.90$29.743.7x3,531
Idaho$106.38$28.373.7x3,093
Oregon$104.40$28.193.7x10,223
West Virginia$103.20$27.293.8x3,254
Alabama$97.61$29.603.3x10,127
Indiana$97.58$28.263.5x20,527
North Dakota$95.59$25.743.7x2,804
Montana$90.58$30.113.0x2,234
South Dakota$89.66$29.403.0x2,981
Kansas$81.40$30.002.7x9,743
Armed Forces Central/South America$75.00$27.552.7x22
Puerto Rico$72.17$41.331.7x414
Guam$53.30$48.551.1x113

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

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