Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous

Medicare Payment (avg)
$17.63
What Medicare actually pays
Billed Charge (avg)
$72.85
What providers submit
Markup
4.1x
313% above Medicare rate
352.5K
Total Services
352.5K
Beneficiaries
10.6K
Providers
54
States with Data

Price Range Across States

Lowest State Avg
$16.06
Nebraska
Highest State Avg
$17.69
Maine

What You Might Pay

Est. Commercial Insurance
$39.49
Range: $27.64 – $55.28
Est. Cash / Self-Pay
$33.25
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: Preventive Screening 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
Maine $17.69 $35.06
Nevada $17.69 $99.69
New Hampshire $17.69 $28.31
Vermont $17.69 $26.87
West Virginia $17.69 $46.44
Guam $17.69 $40.67
U.S. Virgin Islands $17.69 $18.05
Louisiana $17.69 $40.86
Colorado $17.69 $71.01
New Mexico $17.69 $81.26
Minnesota $17.69 $68.94
Wisconsin $17.69 $66.62
Illinois $17.68 $82.31
Kansas $17.68 $103.85
Utah $17.68 $60.27
California $17.68 $90.38
Idaho $17.68 $26.63
Virginia $17.68 $48.67
South Dakota $17.68 $61.09
Massachusetts $17.67 $96.25
Pennsylvania $17.67 $77.07
New Jersey $17.67 $88.60
Ohio $17.67 $62.09
Wyoming $17.67 $40.17
Tennessee $17.66 $44.81
Georgia $17.66 $54.07
Oklahoma $17.65 $65.59
Maryland $17.65 $66.22
Kentucky $17.65 $42.11
Florida $17.65 $77.40
North Carolina $17.65 $86.31
Iowa $17.63 $51.73
Oregon $17.63 $46.47
Missouri $17.63 $45.62
District of Columbia $17.61 $48.15
Hawaii $17.60 $59.07
Arizona $17.59 $66.10
Texas $17.58 $73.56
Arkansas $17.58 $36.03
Indiana $17.56 $43.42
Alabama $17.54 $44.14
Alaska $17.54 $73.58
New York $17.53 $49.80
North Dakota $17.52 $60.22
Mississippi $17.51 $27.05
Washington $17.50 $75.58
Michigan $17.50 $32.80
Delaware $17.45 $43.64
Rhode Island $17.41 $41.84
South Carolina $17.41 $37.76
Connecticut $17.21 $39.12
Puerto Rico $16.99 $18.00
Montana $16.89 $37.72
Nebraska $16.06 $37.82

What the Data Says About Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous

Across 54 states with reporting providers, CPT code G0328 (Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous) shows a national average Medicare payment of $17.63 against an average billed charge of $72.85. That gap — a 4.1x markup, or 313% 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.

Preventive Screening procedures like this one saw 352.5K services billed to Medicare in 2023 by 10.6K distinct providers, serving 352.5K unique beneficiaries. State-level variation is significant: Nebraska reports the lowest average payment at $16.06, while Maine reports the highest at $17.69. 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 Preventive Screening category (2.24x), the estimated commercial insurance price lands near $39.49, with self-pay cash discounts commonly bringing the figure closer to $33.25. 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 Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous cost?

The national average Medicare payment for Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous (CPT G0328) is $17.63, while providers typically bill $72.85. Prices vary significantly by state, ranging from $16.06 to $17.69.

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 Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous cost with insurance?

With commercial insurance, Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous costs an estimated $39.49 on average (range: $27.64 – $55.28). Without insurance, the estimated cash price is $33.25. 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 Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous?

Nebraska has the lowest average Medicare payment for Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous at $16.06, while Maine has the highest at $17.69. This $1.63 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous?

Nationally, 10.6K providers billed Medicare for Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous in 2023, performing 352.5K total services for 352.5K beneficiaries across 54 states and territories.

What is the billed-to-Medicare markup for Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous?

Providers bill 4.1x what Medicare pays for Colorectal Cancer Screening; Fecal Occult Blood Test, Immunoassay, 1-3 Simultaneous — a 313% 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