Other · 0358T

Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report

Medicare Payment (avg)
$13.08
What Medicare actually pays
Billed Charge (avg)
$57.70
What providers submit
Markup
4.4x
341% above Medicare rate
2.8K
Total Services
2.1K
Beneficiaries
154
Providers
19
States with Data

Price Range Across States

Lowest State Avg
$0.01
Delaware
Highest State Avg
$88.33
Missouri

What You Might Pay

Est. Commercial Insurance
$38.40
Range: $26.88 – $53.76
Est. Cash / Self-Pay
$28.72
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Other procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Missouri $88.33 $313.00
New York $25.62 $64.10
Massachusetts $25.59 $50.60
Pennsylvania $23.91 $60.00
Texas $22.11 $118.18
Wisconsin $20.55 $39.36
Maryland $17.39 $52.50
Mississippi $13.49 $45.00
Florida $13.42 $40.42
New Jersey $12.98 $60.98
Washington $7.24 $65.22
Alaska $6.83 $75.00
Oklahoma $6.64 $8.80
California $5.96 $121.34
Nebraska $5.29 $8.00
Arizona $4.03 $75.15
Tennessee $2.32 $11.34
North Carolina $0.01 $0.01
Delaware $0.01 $0.01

What the Data Says About Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report

Across 19 states with reporting providers, CPT code 0358T (Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report) shows a national average Medicare payment of $13.08 against an average billed charge of $57.70. That gap — a 4.4x markup, or 341% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Other procedures like this one saw 2.8K services billed to Medicare in 2023 by 154 distinct providers, serving 2.1K unique beneficiaries. State-level variation is significant: Delaware reports the lowest average payment at $0.01, while Missouri reports the highest at $88.33. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Other category (2.24x), the estimated commercial insurance price lands near $38.40, with self-pay cash discounts commonly bringing the figure closer to $28.72. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report cost?

The national average Medicare payment for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report (CPT 0358T) is $13.08, while providers typically bill $57.70. Prices vary significantly by state, ranging from $0.01 to $88.33.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report cost with insurance?

With commercial insurance, Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report costs an estimated $38.40 on average (range: $26.88 – $53.76). Without insurance, the estimated cash price is $28.72. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report?

Delaware has the lowest average Medicare payment for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report at $0.01, while Missouri has the highest at $88.33. This $88.32 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report?

Nationally, 154 providers billed Medicare for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report in 2023, performing 2.8K total services for 2.1K beneficiaries across 19 states and territories.

What is the billed-to-Medicare markup for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report?

Providers bill 4.4x what Medicare pays for Whole Body Composition Tissue And Fluid Measurements With Interpretation And Report — a 341% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial