19083

Biopsy of breast and placement of locating device using ultrasound, first growth

Medicare pricing data for 10,966 providers across 52 states

🤖AI Overview

This procedure has a 5.7x markup — hospitals charge $1,566 but Medicare allows only $273.13. Uninsured patients may face bills 5.7 times higher than what insurance negotiates. Prices vary significantly by location — from $158 in Idaho to $454 in Maryland. Where you get this procedure matters more than almost any other factor. 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

Biopsy of breast and placement of locating device using ultrasound, first growth (HCPCS code 19083) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $273.13, but hospitals typically charge $1,566 — a 5.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$54.63

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $273.13, your out-of-pocket cost would be approximately $54.63. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$273.13
Average Hospital Charge
$1,566
Markup Ratio
5.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,565.90
Medicare Allowed$273.13
Medicare Payment$213.48

Hospitals charge 5.7x more than what Medicare allows for this procedure. Medicare actually pays $213.48 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Maryland$454$1,6981872,677+66.2%
Arizona$392$1,7851692,251+43.4%
New York$381$2,7136307,532+39.5%
Nevada$375$1,87197689+37.5%
Wyoming$366$1,44535256+34.0%
New Jersey$363$2,0433003,387+33.1%
New Mexico$342$1,98062612+25.2%
California$331$1,72897510,228+21.1%
District of Columbia$328$2,05754802+20.0%
Florida$319$1,7666877,748+16.8%
Washington$315$1,4322762,624+15.3%
Hawaii$314$1,30144369+14.8%
North Carolina$305$1,7714073,661+11.7%
Puerto Rico$303$3912996+11.0%
Colorado$301$2,9941862,099+10.2%
Connecticut$294$1,5761741,350+7.7%
Alaska$289$3,07434350+5.8%
Rhode Island$288$1,38849591+5.5%
Iowa$278$1,6691391,157+1.9%
Minnesota$278$1,6222642,021+1.9%
Kansas$278$1,0111551,137+1.8%
Oregon$276$1,1361411,074+1.0%
Tennessee$274$1,3952982,581+0.4%
Virginia$272$1,3113093,536-0.3%
Georgia$253$1,4323073,016-7.4%
Texas$248$1,6496745,864-9.0%
Delaware$247$93830431-9.5%
New Hampshire$241$2,19078558-11.6%
Mississippi$239$1,252113948-12.6%
Arkansas$238$1,054911,150-13.0%
Nebraska$225$1,393108877-17.7%
Wisconsin$224$2,6393141,926-18.0%
Montana$216$1,04145376-20.7%
Massachusetts$215$1,0502973,108-21.3%
Utah$210$76389591-23.0%
Illinois$202$1,1944914,856-26.1%
Pennsylvania$200$1,0494394,795-26.7%
Alabama$196$1,0111621,148-28.2%
South Dakota$196$64739492-28.2%
South Carolina$196$1,0661472,025-28.4%
Louisiana$193$1,1441571,349-29.3%
Indiana$191$1,1062572,199-30.0%
Kentucky$182$7851411,417-33.3%
Michigan$180$7553263,065-34.2%
Missouri$177$1,0122462,594-35.0%
Maine$176$61672462-35.6%
North Dakota$174$1,51233522-36.2%
Oklahoma$173$1,0901131,496-36.6%
Vermont$172$1,48520242-37.1%
Ohio$171$1,4173423,693-37.5%
West Virginia$163$85665535-40.2%
Idaho$158$98658506-42.2%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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