Detection of endomysial antibody (ema)
Medicare pricing data for 170 providers across 30 states
This procedure has a 9.6x markup — hospitals charge $113.50 but Medicare allows only $11.83. Uninsured patients may face bills 9.6 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
Detection of endomysial antibody (ema) (HCPCS code 86231) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.83, but hospitals typically charge $113.50 — a 9.6x 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 9.6x 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 |
|---|---|---|---|---|---|
| Florida | $12 | $127 | 7 | 1,760 | +0.2% |
| Georgia | $12 | $133 | 2 | 335 | +0.2% |
| Hawaii | $12 | $81 | 2 | 33 | +0.2% |
| Idaho | $12 | $30 | 1 | 11 | +0.2% |
| Indiana | $12 | $78 | 1 | 47 | +0.2% |
| Iowa | $12 | $60 | 6 | 55 | +0.2% |
| Kansas | $12 | $131 | 6 | 330 | +0.2% |
| Massachusetts | $12 | $120 | 3 | 583 | +0.2% |
| Minnesota | $12 | $137 | 4 | 197 | +0.2% |
| Nevada | $12 | $142 | 1 | 68 | +0.2% |
| Oklahoma | $12 | $137 | 2 | 18 | +0.2% |
| Oregon | $12 | $53 | 3 | 164 | +0.2% |
| Tennessee | $12 | $54 | 3 | 262 | +0.2% |
| Texas | $12 | $111 | 9 | 932 | +0.2% |
| Utah | $12 | $29 | 4 | 66 | +0.2% |
| Washington | $12 | $118 | 6 | 1,284 | +0.2% |
| Colorado | $12 | $130 | 2 | 138 | +0.2% |
| New Jersey | $12 | $117 | 10 | 10,753 | +0.1% |
| New York | $12 | $86 | 6 | 2,613 | +0.1% |
| North Carolina | $12 | $119 | 8 | 14,995 | +0.1% |
| California | $12 | $87 | 17 | 2,047 | +0.1% |
| Maryland | $12 | $115 | 5 | 154 | -0.1% |
| Ohio | $12 | $106 | 8 | 2,297 | -0.1% |
| Illinois | $12 | $131 | 9 | 120 | -0.3% |
| Alabama | $12 | $111 | 2 | 2,836 | -0.3% |
| Pennsylvania | $12 | $128 | 5 | 135 | -0.5% |
| Arizona | $12 | $142 | 3 | 362 | -0.6% |
| Virginia | $12 | $50 | 5 | 67 | -1.1% |
| Mississippi | $12 | $66 | 2 | 42 | -1.3% |
| Michigan | $11 | $97 | 5 | 140 | -5.3% |
⚠️ 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