81541

Gene analysis of prostate tumor tissue, profiling by real-time rt-pcr of 46 genes

Medicare pricing data for 1 providers across 1 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 of prostate tumor tissue, profiling by real-time rt-pcr of 46 genes (HCPCS code 81541) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $3,777, but hospitals typically charge $3,900 — a 1.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$755.37

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $3,777, your out-of-pocket cost would be approximately $755.37. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$3,777
Average Hospital Charge
$3,900
Markup Ratio
1.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$3,900.00
Medicare Allowed$3,776.86
Medicare Payment$3,776.86

Hospitals charge 1.0x more than what Medicare allows for this procedure. Medicare actually pays $3,777 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Utah$3,777$3,90018,6260.0%

⚠️ 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