84145

Procalcitonin (hormone) level

Medicare pricing data for 447 providers across 43 states

🤖AI Overview

This procedure has a 7.9x markup — hospitals charge $209.21 but Medicare allows only $26.63. Uninsured patients may face bills 7.9 times higher than what insurance negotiates. 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

Procalcitonin (hormone) level (HCPCS code 84145) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $26.63, but hospitals typically charge $209.21 — a 7.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.33

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $26.63, your out-of-pocket cost would be approximately $5.33. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$26.63
Average Hospital Charge
$209.21
Markup Ratio
7.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$209.21
Medicare Allowed$26.63
Medicare Payment$26.63

Hospitals charge 7.9x more than what Medicare allows for this procedure. Medicare actually pays $26.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$27$3202149+0.2%
Hawaii$27$763119+0.2%
Idaho$27$144247+0.2%
Indiana$27$184326+0.2%
Kansas$27$3367442+0.2%
Kentucky$27$53346+0.2%
Louisiana$27$1015209+0.2%
Maryland$27$292674+0.2%
Massachusetts$27$17914349+0.2%
Michigan$27$92861+0.2%
Mississippi$27$51459+0.2%
Missouri$27$128321+0.2%
Nevada$27$994762+0.2%
New Mexico$27$136236+0.2%
New York$27$16241,078+0.2%
Oklahoma$27$1847118+0.2%
Pennsylvania$27$3129308+0.2%
Rhode Island$27$701396+0.2%
South Dakota$27$194333+0.2%
Tennessee$27$2104179+0.2%
Utah$27$73428+0.2%
Wyoming$27$1131057+0.2%
Alabama$27$3274364+0.2%
Arizona$27$2744308+0.2%
Arkansas$27$1081331+0.2%
Colorado$27$230565+0.2%
Connecticut$27$396221+0.2%
New Jersey$27$284111,957+0.2%
California$27$185413,749+0.1%
Florida$27$247131,570+0.0%
Illinois$27$225171,251+0.0%
North Carolina$27$2954965-0.1%
Texas$27$25126725-0.1%
Ohio$27$13314646-0.1%
Virginia$27$9310358-0.2%
Washington$27$3096280-0.3%
Iowa$27$1716134-0.4%
Nebraska$27$1172116-0.5%
North Dakota$26$1449111-0.8%
Wisconsin$26$15813653-0.8%
Oregon$26$247370-0.9%
Minnesota$26$108113357-1.4%
South Carolina$26$285833-2.3%

⚠️ 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