86300

Immunologic analysis for detection of tumor antigen, quantitative; ca 15-3

Medicare pricing data for 2,356 providers across 46 states

🤖AI Overview

This procedure has a 5.8x markup — hospitals charge $117.80 but Medicare allows only $20.19. Uninsured patients may face bills 5.8 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

Immunologic analysis for detection of tumor antigen, quantitative; ca 15-3 (HCPCS code 86300) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.19, but hospitals typically charge $117.80 — a 5.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.04

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $20.19, your out-of-pocket cost would be approximately $4.04. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$20.19
Average Hospital Charge
$117.80
Markup Ratio
5.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$117.80
Medicare Allowed$20.19
Medicare Payment$20.19

Hospitals charge 5.8x more than what Medicare allows for this procedure. Medicare actually pays $20.19 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$20$1241112+1.0%
Iowa$20$6323523+1.0%
Kentucky$20$74389+1.0%
Rhode Island$20$56246+1.0%
South Dakota$20$1123231+1.0%
Wyoming$20$1717390+1.0%
Connecticut$20$677231+1.0%
Kansas$20$151167,510+0.9%
Massachusetts$20$155132,028+0.9%
New Jersey$20$1352431,944+0.9%
New Mexico$20$6991,323+0.9%
Oklahoma$20$9713877+0.9%
Florida$20$1018655,808+0.8%
Georgia$20$140373,969+0.8%
Maryland$20$120525,215+0.8%
New York$20$13922220,947+0.8%
Puerto Rico$20$231641,001+0.8%
Nebraska$20$61221,336+0.7%
North Carolina$20$1403710,600+0.7%
Pennsylvania$20$124296,581+0.7%
Texas$20$11435639,730+0.7%
Arizona$20$1261814,323+0.7%
Illinois$20$1451116,562+0.6%
Nevada$20$133406,546+0.6%
Ohio$20$124447,153+0.6%
Indiana$20$137211,177+0.6%
Maine$20$4422886+0.6%
Minnesota$20$1741183,037+0.6%
West Virginia$20$5312164+0.6%
Colorado$20$128495,978+0.6%
Hawaii$20$10421,259+0.5%
Utah$20$57361,266+0.5%
Louisiana$20$1217178+0.4%
Tennessee$20$571327,650+0.4%
Wisconsin$20$123132,064+0.4%
Oregon$20$104411,578+0.4%
South Carolina$20$114524,906+0.4%
Virginia$20$1201067,622+0.4%
Washington$20$115535,473+0.3%
Alabama$20$102676,535+0.3%
Arkansas$20$65537,663+0.3%
Missouri$20$30515416+0.2%
Michigan$20$6428709+0.1%
North Dakota$20$11112433+0.1%
Mississippi$20$117264,290-1.3%
California$20$12014356,603-3.3%

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

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