86037

Antineutrophil cytoplasmic antibody titer

Medicare pricing data for 204 providers across 31 states

🤖AI Overview

This procedure has a 9.0x markup — hospitals charge $105.67 but Medicare allows only $11.78. Uninsured patients may face bills 9.0 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

Antineutrophil cytoplasmic antibody titer (HCPCS code 86037) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.78, but hospitals typically charge $105.67 — a 9.0x 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 $11.78, 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
$11.78
Average Hospital Charge
$105.67
Markup Ratio
9.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$105.67
Medicare Allowed$11.78
Medicare Payment$11.78

Hospitals charge 9.0x more than what Medicare allows for this procedure. Medicare actually pays $11.78 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$12$11762,894+0.3%
Georgia$12$1413262+0.3%
Hawaii$12$125139+0.3%
Indiana$12$862123+0.3%
Kansas$12$843932+0.3%
Louisiana$12$95157+0.3%
Massachusetts$12$1472281+0.3%
Michigan$12$871143+0.3%
Missouri$12$24352+0.3%
Nevada$12$1471219+0.3%
New Jersey$12$104915,594+0.3%
New Mexico$12$110154+0.3%
New York$12$446329+0.3%
Oklahoma$12$140279+0.3%
Oregon$12$109272+0.3%
Pennsylvania$12$104471+0.3%
South Dakota$12$63114+0.3%
Tennessee$12$972589+0.3%
Texas$12$10985,478+0.3%
Washington$12$9741,375+0.3%
Alabama$12$10524,890+0.3%
Arizona$12$11732,919+0.3%
Colorado$12$11241,221+0.3%
North Carolina$12$1101235,656+0.2%
Ohio$12$10566,388+0.2%
California$12$92188,864+0.2%
Wisconsin$12$57642-0.5%
Minnesota$12$4367152-0.8%
Illinois$12$1297155-1.7%
Maryland$11$143377-3.7%
Virginia$7$142545-39.6%

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

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