81005

Analysis of urine, except immunoassays

Medicare pricing data for 187 providers across 22 states

🤖AI Overview

This procedure has a 7.8x markup — hospitals charge $16.56 but Medicare allows only $2.13. Uninsured patients may face bills 7.8 times higher than what insurance negotiates. 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

Analysis of urine, except immunoassays (HCPCS code 81005) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $2.13, but hospitals typically charge $16.56 — a 7.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$0.43

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $2.13, your out-of-pocket cost would be approximately $0.43. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$2.13
Average Hospital Charge
$16.56
Markup Ratio
7.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$16.56
Medicare Allowed$2.13
Medicare Payment$2.13

Hospitals charge 7.8x more than what Medicare allows for this procedure. Medicare actually pays $2.13 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$2$3919402+0.5%
Georgia$2$442130.0%
Illinois$2$4458860.0%
Kansas$2$462230.0%
Louisiana$2$136160.0%
Maryland$2$1042,5140.0%
Michigan$2$331020.0%
Nevada$2$422070.0%
New Jersey$2$16161780.0%
New York$2$19222,3340.0%
Pennsylvania$2$224250.0%
Virginia$2$502380.0%
Washington$2$106710.0%
Puerto Rico$2$41170.0%
Alabama$2$41510.0%
Arizona$2$87110.0%
Arkansas$2$462180.0%
California$2$10171,4440.0%
Mississippi$2$57384-0.5%
Texas$2$3327327-0.5%
Tennessee$2$77161-0.9%
Ohio$2$6231-5.2%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber