81351

Gene analysis (tumor protein 53) full sequence analysis

Medicare pricing data for 44 providers across 5 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 (tumor protein 53) full sequence analysis (HCPCS code 81351) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $628.71, but hospitals typically charge $729.35 — a 1.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$125.74

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $628.71, your out-of-pocket cost would be approximately $125.74. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$628.71
Average Hospital Charge
$729.35
Markup Ratio
1.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$729.35
Medicare Allowed$628.71
Medicare Payment$628.71

Hospitals charge 1.2x more than what Medicare allows for this procedure. Medicare actually pays $628.71 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$629$702416+0.0%
Pennsylvania$629$642214+0.0%
Florida$629$7282710,296+0.0%
Tennessee$605$1,284115-3.7%
Maryland$564$575112-10.4%

⚠️ 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