0012M

Molecular pathology test for genetic analysis of bladder tumor (cxbladder detect)

Medicare pricing data for 1 providers across 1 states

🤖AI Overview

This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Molecular pathology test for genetic analysis of bladder tumor (cxbladder detect) (HCPCS code 0012M) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $744.56, but hospitals typically charge $2,995 — a 4.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$148.91

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $744.56, your out-of-pocket cost would be approximately $148.91. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$744.56
Average Hospital Charge
$2,995
Markup Ratio
4.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,995.00
Medicare Allowed$744.56
Medicare Payment$744.56

Hospitals charge 4.0x more than what Medicare allows for this procedure. Medicare actually pays $744.56 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Pennsylvania$745$2,99516,1580.0%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber