Measurement of complement function (immune system proteins)
Medicare pricing data for 227 providers across 29 states
This procedure has a 8.3x markup — hospitals charge $97.50 but Medicare allows only $11.73. Uninsured patients may face bills 8.3 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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
Measurement of complement function (immune system proteins) (HCPCS code 86161) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.73, but hospitals typically charge $97.50 — a 8.3x 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 $11.73, your out-of-pocket cost would be approximately $2.35. 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 8.3x more than what Medicare allows for this procedure. Medicare actually pays $11.73 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Florida | $12 | $76 | 17 | 1,421 | +0.3% |
| Georgia | $12 | $111 | 3 | 112 | +0.3% |
| Kansas | $12 | $136 | 3 | 113 | +0.3% |
| Maryland | $12 | $83 | 4 | 46 | +0.3% |
| Minnesota | $12 | $170 | 4 | 95 | +0.3% |
| Nevada | $12 | $106 | 2 | 26 | +0.3% |
| New Jersey | $12 | $161 | 7 | 640 | +0.3% |
| New Mexico | $12 | $40 | 1 | 11 | +0.3% |
| New York | $12 | $116 | 6 | 132 | +0.3% |
| North Carolina | $12 | $188 | 8 | 810 | +0.3% |
| Ohio | $12 | $144 | 7 | 68 | +0.3% |
| Oklahoma | $12 | $112 | 3 | 36 | +0.3% |
| Oregon | $12 | $86 | 4 | 19 | +0.3% |
| Pennsylvania | $12 | $106 | 7 | 62 | +0.3% |
| Tennessee | $12 | $109 | 3 | 34 | +0.3% |
| Utah | $12 | $27 | 2 | 29 | +0.3% |
| Virginia | $12 | $57 | 4 | 30 | +0.3% |
| Washington | $12 | $156 | 2 | 68 | +0.3% |
| Wisconsin | $12 | $134 | 5 | 47 | +0.3% |
| Alabama | $12 | $217 | 4 | 79 | +0.3% |
| Arizona | $12 | $145 | 3 | 129 | +0.3% |
| Arkansas | $12 | $12 | 1 | 45 | +0.3% |
| Colorado | $12 | $228 | 2 | 130 | +0.3% |
| Puerto Rico | $12 | $14 | 64 | 114 | +0.1% |
| Texas | $12 | $111 | 14 | 629 | -0.2% |
| California | $12 | $54 | 18 | 2,755 | -0.3% |
| South Carolina | $12 | $55 | 2 | 130 | -0.5% |
| Massachusetts | $12 | $77 | 8 | 367 | -0.9% |
| Illinois | $12 | $111 | 2 | 71 | -1.0% |
⚠️ 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