84166

Protein measurement, body fluid

Medicare pricing data for 2,070 providers across 50 states

🤖AI Overview

This procedure has a 5.5x markup — hospitals charge $95.58 but Medicare allows only $17.52. Uninsured patients may face bills 5.5 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

Protein measurement, body fluid (HCPCS code 84166) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $17.52, but hospitals typically charge $95.58 — a 5.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.50

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $17.52, your out-of-pocket cost would be approximately $3.50. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$17.52
Average Hospital Charge
$95.58
Markup Ratio
5.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$95.58
Medicare Allowed$17.52
Medicare Payment$16.19

Hospitals charge 5.5x more than what Medicare allows for this procedure. Medicare actually pays $16.19 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$19$573117+6.9%
Connecticut$18$77191,439+5.3%
Massachusetts$18$93579,622+4.6%
New York$18$90816,892+3.0%
California$18$10315021,162+2.5%
Maryland$18$96304,127+1.8%
New Mexico$18$737475+1.5%
Illinois$18$921066,729+1.1%
Rhode Island$18$599678+1.0%
Washington$18$90402,987+0.9%
Delaware$18$82290+0.8%
Colorado$18$104211,198+0.5%
Hawaii$18$54161,195+0.4%
Montana$18$40365+0.4%
Oregon$18$5024721+0.2%
New Jersey$18$9810423,0000.0%
Pennsylvania$17$84786,547-0.2%
Texas$17$10011321,763-0.3%
Arizona$17$132164,429-0.3%
Nevada$17$11121,131-0.4%
Florida$17$10311417,450-0.5%
Georgia$17$100605,964-0.6%
Virginia$17$65262,581-0.7%
Kansas$17$106192,817-0.8%
South Dakota$17$6825376-0.9%
Michigan$17$75776,098-0.9%
North Carolina$17$1174114,354-1.0%
Puerto Rico$17$1986402-1.0%
Maine$17$498870-1.0%
New Hampshire$17$1154168-1.2%
West Virginia$17$75461-1.5%
Minnesota$17$1292074,644-1.7%
Louisiana$17$11215419-2.0%
North Dakota$17$6712487-2.0%
Alabama$17$106464,437-2.0%
Iowa$17$65351,044-2.1%
Ohio$17$761089,274-2.2%
Wisconsin$17$96472,625-2.3%
Utah$17$37211,064-2.5%
Kentucky$17$7216353-2.5%
Missouri$17$70481,183-2.5%
Nebraska$17$43151,247-2.6%
Oklahoma$17$64181,515-3.1%
South Carolina$17$6618376-3.4%
Indiana$17$64371,073-3.7%
Idaho$17$4020293-4.2%
Tennessee$17$103323,835-4.5%
Arkansas$16$4061,616-6.5%
Mississippi$16$526110-7.1%
Vermont$16$55113-10.4%

⚠️ 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