81223

Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence

Medicare pricing data for 100 providers across 12 states

🤖AI Overview

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 (cystic fibrosis transmembrane conductance regular) full gene sequence (HCPCS code 81223) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $474.68, but hospitals typically charge $576.78 — a 1.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$94.94

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $474.68, your out-of-pocket cost would be approximately $94.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$474.68
Average Hospital Charge
$576.78
Markup Ratio
1.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$576.78
Medicare Allowed$474.68
Medicare Payment$474.68

Hospitals charge 1.2x more than what Medicare allows for this procedure. Medicare actually pays $474.68 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Louisiana$489$6612179+3.0%
Maryland$489$2,494211+3.0%
Mississippi$489$1,500130+3.0%
New Jersey$489$59595,755+3.0%
New York$489$2,196213+3.0%
Pennsylvania$489$50442,401+3.0%
Colorado$489$2,042490+3.0%
Florida$489$6072815,516+2.9%
Oklahoma$487$6672237+2.5%
Arizona$466$6501102-1.9%
Minnesota$464$1,499218-2.2%
Texas$446$5213911,989-6.0%

⚠️ 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