85097

Bone marrow, smear interpretation

Medicare pricing data for 4,005 providers across 52 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

Bone marrow, smear interpretation (HCPCS code 85097) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $52.35, but hospitals typically charge $241.81 — a 4.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$10.47

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $52.35, your out-of-pocket cost would be approximately $10.47. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$52.35
Average Hospital Charge
$241.81
Markup Ratio
4.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$241.81
Medicare Allowed$52.35
Medicare Payment$41.39

Hospitals charge 4.6x more than what Medicare allows for this procedure. Medicare actually pays $41.39 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$69$2541115,332+31.3%
Puerto Rico$68$69515+29.9%
Alaska$63$4121195+20.9%
Connecticut$60$264641,966+14.7%
California$58$24942915,060+11.4%
Florida$56$22824911,681+7.9%
Hawaii$56$21426292+6.9%
New York$55$2891937,604+5.9%
North Dakota$54$25316393+2.4%
Tennessee$54$250844,020+2.2%
Nevada$53$16327736+0.7%
District of Columbia$52$25513349-0.4%
Texas$52$28432312,910-1.1%
New Mexico$52$29526500-1.4%
Idaho$52$17216274-1.5%
Illinois$51$2621884,816-2.4%
Washington$51$167962,659-2.5%
Maryland$51$203912,018-2.6%
Massachusetts$51$2251114,309-3.2%
Oregon$51$25332849-3.2%
Minnesota$51$3131243,096-3.5%
Alabama$50$181531,263-4.2%
Louisiana$50$194531,453-4.3%
Arizona$49$229923,823-5.6%
Montana$49$17015473-5.9%
Pennsylvania$49$2531464,945-5.9%
Nebraska$49$18431902-6.5%
Oklahoma$49$205361,287-7.1%
Georgia$48$2091162,482-7.8%
Rhode Island$48$1959111-7.8%
Iowa$48$299511,547-7.9%
Virginia$48$251832,914-8.2%
Colorado$48$217631,795-8.3%
South Dakota$48$20617588-8.5%
Delaware$48$2428196-8.6%
South Carolina$48$204642,368-8.9%
New Hampshire$48$46318393-9.0%
Utah$48$18234999-9.1%
Arkansas$48$189462,752-9.1%
Michigan$47$1671303,285-9.4%
North Carolina$47$201932,895-9.7%
Kansas$47$190551,958-9.9%
West Virginia$47$21031534-10.3%
Wisconsin$47$371892,918-10.4%
Missouri$47$226892,690-10.4%
Wyoming$47$183412-10.6%
Maine$47$16120401-10.7%
Ohio$47$2241593,861-10.7%
Indiana$46$189801,729-11.5%
Vermont$46$27210280-11.6%
Kentucky$46$196411,159-13.1%
Mississippi$45$19622664-13.6%

⚠️ 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