81210

Gene analysis (v-raf murine sarcoma viral oncogene homolog b1)

Medicare pricing data for 95 providers across 22 states

🤖AI Overview

Prices vary significantly by location — from $61 in Indiana to $172 in Georgia. Where you get this procedure matters more than almost any other factor. 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

Gene analysis (v-raf murine sarcoma viral oncogene homolog b1) (HCPCS code 81210) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $171.28, but hospitals typically charge $276.71 — a 1.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$34.26

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $171.28, your out-of-pocket cost would be approximately $34.26. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$171.28
Average Hospital Charge
$276.71
Markup Ratio
1.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$276.71
Medicare Allowed$171.28
Medicare Payment$171.28

Hospitals charge 1.6x more than what Medicare allows for this procedure. Medicare actually pays $171.28 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$172$4391116+0.4%
Illinois$172$403398+0.4%
Minnesota$172$1,024281+0.4%
New Mexico$172$789115+0.4%
North Carolina$172$860179+0.4%
Tennessee$172$457244+0.4%
Utah$172$661335+0.4%
Washington$172$207489+0.4%
Wisconsin$172$421318+0.4%
Arizona$172$445280+0.4%
Arkansas$172$259211+0.4%
Connecticut$172$4413246+0.4%
Florida$172$192194,925+0.3%
California$172$2716914+0.2%
Colorado$172$5014472+0.1%
New Jersey$171$8093144-0.3%
Pennsylvania$170$637412-0.7%
Maine$169$255252-1.3%
Texas$168$473973-1.7%
Oklahoma$168$521313-2.0%
Maryland$121$249114-29.3%
Indiana$61$80123-64.2%

⚠️ 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