81260

Gene analysis (inhibitor of kappa light polypeptide gene enhancer in b-cells, kinase complex-associated protein) common variants

Medicare pricing data for 37 providers across 8 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 (inhibitor of kappa light polypeptide gene enhancer in b-cells, kinase complex-associated protein) common variants (HCPCS code 81260) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $38.52, but hospitals typically charge $43.41 — a 1.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$7.70

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $38.52, your out-of-pocket cost would be approximately $7.70. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$38.52
Average Hospital Charge
$43.41
Markup Ratio
1.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$43.41
Medicare Allowed$38.52
Medicare Payment$38.52

Hospitals charge 1.1x more than what Medicare allows for this procedure. Medicare actually pays $38.52 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$39$43111,9860.0%
Louisiana$39$401150.0%
Oklahoma$39$6632450.0%
Pennsylvania$39$3911,1070.0%
Texas$39$40126,1550.0%
Arizona$39$501600.0%
Colorado$39$1701130.0%
New Jersey$39$4962,981-0.0%

⚠️ 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