Screening test for antibody to noninfectious agent
Medicare pricing data for 725 providers across 45 states
This procedure has a 12.6x markup — hospitals charge $155.01 but Medicare allows only $12.35. Uninsured patients may face bills 12.6 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
Screening test for antibody to noninfectious agent (HCPCS code 86255) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.35, but hospitals typically charge $155.01 — a 12.6x 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 $12.35, your out-of-pocket cost would be approximately $2.47. 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 12.6x more than what Medicare allows for this procedure. Medicare actually pays $11.93 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| West Virginia | $17 | $51 | 1 | 13 | +36.0% |
| New Hampshire | $16 | $82 | 4 | 281 | +32.2% |
| Missouri | $16 | $46 | 15 | 203 | +32.0% |
| Arkansas | $16 | $37 | 13 | 125 | +28.7% |
| Iowa | $16 | $104 | 18 | 787 | +27.4% |
| Connecticut | $15 | $117 | 3 | 131 | +22.5% |
| Michigan | $15 | $84 | 16 | 918 | +20.6% |
| Massachusetts | $14 | $228 | 16 | 3,000 | +11.3% |
| Pennsylvania | $14 | $121 | 18 | 1,450 | +11.3% |
| Indiana | $14 | $74 | 15 | 421 | +9.6% |
| Colorado | $14 | $158 | 10 | 519 | +9.3% |
| Texas | $13 | $121 | 117 | 14,771 | +7.9% |
| Illinois | $13 | $135 | 40 | 2,261 | +7.4% |
| Ohio | $12 | $133 | 20 | 1,083 | +1.0% |
| California | $12 | $117 | 46 | 12,426 | +0.5% |
| New Jersey | $12 | $163 | 23 | 7,262 | -2.5% |
| Wisconsin | $12 | $125 | 9 | 733 | -2.8% |
| North Carolina | $12 | $181 | 15 | 10,598 | -3.1% |
| Florida | $12 | $195 | 41 | 12,878 | -3.9% |
| New York | $12 | $146 | 45 | 8,023 | -4.1% |
| District of Columbia | $12 | $83 | 4 | 236 | -4.4% |
| Georgia | $12 | $196 | 13 | 3,871 | -4.4% |
| Hawaii | $12 | $178 | 2 | 515 | -4.4% |
| Kansas | $12 | $283 | 9 | 2,990 | -4.4% |
| Maine | $12 | $707 | 1 | 34 | -4.4% |
| Mississippi | $12 | $247 | 7 | 37 | -4.4% |
| New Mexico | $12 | $149 | 2 | 111 | -4.4% |
| North Dakota | $12 | $108 | 3 | 20 | -4.4% |
| Rhode Island | $12 | $47 | 1 | 31 | -4.4% |
| South Dakota | $12 | $109 | 5 | 360 | -4.4% |
| Utah | $12 | $84 | 5 | 482 | -4.4% |
| Alabama | $12 | $156 | 6 | 469 | -4.4% |
| Minnesota | $12 | $165 | 15 | 7,124 | -4.5% |
| Arizona | $12 | $155 | 5 | 1,995 | -4.5% |
| Maryland | $12 | $105 | 33 | 3,079 | -4.9% |
| Oklahoma | $12 | $119 | 9 | 883 | -4.9% |
| Washington | $12 | $225 | 22 | 310 | -4.9% |
| Puerto Rico | $12 | $14 | 32 | 59 | -5.0% |
| Virginia | $12 | $176 | 8 | 594 | -5.3% |
| Oregon | $12 | $59 | 6 | 507 | -5.7% |
| Tennessee | $12 | $138 | 10 | 591 | -5.7% |
| Kentucky | $12 | $88 | 5 | 317 | -5.8% |
| Nevada | $11 | $170 | 2 | 924 | -8.6% |
| South Carolina | $11 | $166 | 5 | 51 | -13.8% |
| Louisiana | $10 | $152 | 5 | 25 | -16.8% |
⚠️ 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