81343

Gene analysis (protein phosphatase 2 regulatory subunit bbeta) for abnormal alleles

Medicare pricing data for 22 providers across 7 states

🤖AI Overview

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 (protein phosphatase 2 regulatory subunit bbeta) for abnormal alleles (HCPCS code 81343) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $134.26, but hospitals typically charge $158.72 — a 1.2x 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
$158.72
Markup Ratio
1.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$158.72
Medicare Allowed$134.26
Medicare Payment$134.26

Hospitals charge 1.2x 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
Louisiana$134$1611470.0%
New Jersey$134$16643,0250.0%
Oklahoma$134$1901580.0%
Pennsylvania$134$13711,1030.0%
Texas$134$14641,1890.0%
Colorado$134$6021140.0%
Florida$134$17410503-0.0%

⚠️ 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