86036

Screening test for antineutrophil cytoplasmic antibody

Medicare pricing data for 362 providers across 37 states

🤖AI Overview

This procedure has a 11.3x markup — hospitals charge $133.35 but Medicare allows only $11.80. Uninsured patients may face bills 11.3 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

Screening test for antineutrophil cytoplasmic antibody (HCPCS code 86036) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.80, but hospitals typically charge $133.35 — a 11.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.36

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.80, your out-of-pocket cost would be approximately $2.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.80
Average Hospital Charge
$133.35
Markup Ratio
11.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$133.35
Medicare Allowed$11.80
Medicare Payment$11.80

Hospitals charge 11.3x more than what Medicare allows for this procedure. Medicare actually pays $11.80 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$12$14812,604+0.1%
Idaho$12$39224+0.1%
Illinois$12$14731,480+0.1%
Kansas$12$14441,512+0.1%
Kentucky$12$291076+0.1%
Maryland$12$1393583+0.1%
Massachusetts$12$14731,424+0.1%
New Jersey$12$18876,856+0.1%
New Mexico$12$1452335+0.1%
New York$12$1398471+0.1%
Pennsylvania$12$12151,021+0.1%
South Carolina$12$53376+0.1%
Tennessee$12$9721,209+0.1%
Texas$12$120206,688+0.1%
Utah$12$3217765+0.1%
Alabama$12$1062356+0.1%
Colorado$12$1355407+0.1%
Connecticut$12$36152+0.1%
Florida$12$14885,4390.0%
North Carolina$12$108182,7920.0%
California$12$1172211,2830.0%
Nevada$12$1481776-0.1%
Virginia$12$436443-0.1%
Mississippi$12$915153-0.2%
Arizona$12$19141,992-0.2%
Minnesota$12$1481361,601-0.3%
Ohio$12$808948-0.3%
Oklahoma$12$13851,318-0.3%
Hawaii$12$1172778-0.3%
Indiana$12$744155-0.4%
Washington$12$13051,109-0.5%
Iowa$12$324428-0.7%
Maine$12$1312186-0.8%
South Dakota$12$644198-0.8%
Oregon$12$72212-1.0%
Wisconsin$12$737232-1.1%
North Dakota$11$53526-9.7%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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