81311

Gene analysis for cancer (neuroblastoma)

Medicare pricing data for 72 providers across 6 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 for cancer (neuroblastoma) (HCPCS code 81311) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $289.83, but hospitals typically charge $333.65 — a 1.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$57.97

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $289.83, your out-of-pocket cost would be approximately $57.97. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$289.83
Average Hospital Charge
$333.65
Markup Ratio
1.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$333.65
Medicare Allowed$289.83
Medicare Payment$289.83

Hospitals charge 1.2x more than what Medicare allows for this procedure. Medicare actually pays $289.83 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Illinois$290$574242+0.0%
Maine$290$432111+0.0%
New Jersey$290$376473+0.0%
Pennsylvania$290$296227+0.0%
Florida$290$3322514,707+0.0%
Texas$288$38715114-0.6%

⚠️ 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