Screening test for autoimmune disorder
Medicare pricing data for 4,466 providers across 50 states
This procedure has a 6.7x markup — hospitals charge $78.70 but Medicare allows only $11.83. Uninsured patients may face bills 6.7 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 autoimmune disorder (HCPCS code 86038) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.83, but hospitals typically charge $78.70 — a 6.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.83, your out-of-pocket cost would be approximately $2.37. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 6.7x more than what Medicare allows for this procedure. Medicare actually pays $11.83 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Delaware | $12 | $23 | 3 | 23 | +0.2% |
| District of Columbia | $12 | $41 | 5 | 30 | +0.2% |
| Georgia | $12 | $87 | 65 | 24,154 | +0.2% |
| Kansas | $12 | $88 | 57 | 16,364 | +0.2% |
| Massachusetts | $12 | $82 | 314 | 13,344 | +0.2% |
| Montana | $12 | $34 | 3 | 26 | +0.2% |
| New Hampshire | $12 | $64 | 21 | 68 | +0.2% |
| New Mexico | $12 | $45 | 9 | 1,866 | +0.2% |
| Rhode Island | $12 | $67 | 5 | 618 | +0.2% |
| Wyoming | $12 | $47 | 10 | 43 | +0.2% |
| Puerto Rico | $12 | $13 | 277 | 1,361 | +0.2% |
| Florida | $12 | $85 | 117 | 64,843 | +0.1% |
| Idaho | $12 | $36 | 26 | 448 | +0.1% |
| New Jersey | $12 | $86 | 276 | 97,960 | +0.1% |
| New York | $12 | $101 | 259 | 33,400 | +0.1% |
| California | $12 | $62 | 116 | 116,148 | +0.1% |
| Colorado | $12 | $88 | 20 | 3,502 | +0.1% |
| Illinois | $12 | $78 | 323 | 17,257 | 0.0% |
| Nevada | $12 | $86 | 6 | 5,436 | 0.0% |
| Texas | $12 | $84 | 400 | 69,201 | 0.0% |
| Maryland | $12 | $71 | 55 | 8,886 | -0.1% |
| North Carolina | $12 | $89 | 123 | 66,395 | -0.1% |
| Pennsylvania | $12 | $70 | 50 | 10,065 | -0.1% |
| Arizona | $12 | $77 | 119 | 28,337 | -0.1% |
| Michigan | $12 | $39 | 22 | 2,924 | -0.2% |
| Ohio | $12 | $76 | 212 | 23,401 | -0.2% |
| Tennessee | $12 | $55 | 59 | 8,718 | -0.2% |
| Alabama | $12 | $86 | 55 | 19,051 | -0.2% |
| Hawaii | $12 | $50 | 2 | 4,249 | -0.3% |
| Indiana | $12 | $48 | 48 | 1,353 | -0.3% |
| Minnesota | $12 | $91 | 610 | 4,588 | -0.3% |
| Nebraska | $12 | $39 | 10 | 591 | -0.3% |
| Oklahoma | $12 | $54 | 61 | 7,753 | -0.3% |
| North Dakota | $12 | $51 | 13 | 426 | -0.3% |
| South Dakota | $12 | $70 | 7 | 688 | -0.3% |
| Utah | $12 | $26 | 57 | 522 | -0.3% |
| Washington | $12 | $75 | 47 | 8,565 | -0.3% |
| Oregon | $12 | $41 | 11 | 2,648 | -0.4% |
| Iowa | $12 | $62 | 59 | 1,436 | -0.5% |
| Virginia | $12 | $37 | 40 | 4,202 | -0.5% |
| Maine | $12 | $49 | 2 | 434 | -0.6% |
| Missouri | $12 | $72 | 105 | 477 | -0.6% |
| Connecticut | $12 | $78 | 5 | 205 | -0.7% |
| Kentucky | $12 | $40 | 20 | 1,675 | -0.8% |
| South Carolina | $12 | $36 | 54 | 1,329 | -0.8% |
| Louisiana | $12 | $67 | 98 | 1,080 | -1.0% |
| Wisconsin | $12 | $97 | 50 | 4,409 | -1.3% |
| Mississippi | $12 | $70 | 34 | 903 | -1.6% |
| Arkansas | $12 | $34 | 102 | 868 | -1.6% |
| West Virginia | $11 | $100 | 13 | 21 | -9.4% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber