81312

Gene analysis (poly[a] binding protein nuclear 1) for abnormal alleles

Medicare pricing data for 36 providers across 9 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 (poly[a] binding protein nuclear 1) for abnormal alleles (HCPCS code 81312) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $134.26, but hospitals typically charge $152.23 — a 1.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$26.85

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $134.26, your out-of-pocket cost would be approximately $26.85. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$134.26
Average Hospital Charge
$152.23
Markup Ratio
1.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$152.23
Medicare Allowed$134.26
Medicare Payment$134.26

Hospitals charge 1.1x more than what Medicare allows for this procedure. Medicare actually pays $134.26 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$134$164108460.0%
Louisiana$134$1682280.0%
Maryland$134$4251530.0%
New Jersey$134$16633,0230.0%
Oklahoma$134$18632870.0%
Pennsylvania$134$13711,1010.0%
Texas$134$142126,2370.0%
Arizona$134$1501600.0%
Colorado$134$5941130.0%

⚠️ 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