Immunologic analysis for detection of tumor antigen, quantitative; ca 19-9
Medicare pricing data for 1,658 providers across 42 states
This procedure has a 5.9x markup — hospitals charge $119.63 but Medicare allows only $20.37. Uninsured patients may face bills 5.9 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 19-9 (HCPCS code 86301) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.37, but hospitals typically charge $119.63 — a 5.9x 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 $20.37, your out-of-pocket cost would be approximately $4.07. 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 5.9x more than what Medicare allows for this procedure. Medicare actually pays $20.37 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Georgia | $20 | $138 | 31 | 2,914 | +0.1% |
| Illinois | $20 | $118 | 124 | 1,983 | +0.1% |
| Kentucky | $20 | $76 | 3 | 53 | +0.1% |
| Louisiana | $20 | $150 | 7 | 210 | +0.1% |
| Maryland | $20 | $114 | 42 | 1,278 | +0.1% |
| Massachusetts | $20 | $143 | 38 | 1,215 | +0.1% |
| Michigan | $20 | $66 | 28 | 722 | +0.1% |
| Minnesota | $20 | $187 | 86 | 1,991 | +0.1% |
| Missouri | $20 | $98 | 18 | 76 | +0.1% |
| Nebraska | $20 | $60 | 1 | 297 | +0.1% |
| New Mexico | $20 | $80 | 6 | 299 | +0.1% |
| Oklahoma | $20 | $103 | 4 | 609 | +0.1% |
| Rhode Island | $20 | $65 | 1 | 27 | +0.1% |
| South Dakota | $20 | $78 | 3 | 79 | +0.1% |
| Arkansas | $20 | $65 | 31 | 689 | +0.1% |
| Colorado | $20 | $165 | 5 | 380 | +0.1% |
| Kansas | $20 | $137 | 18 | 3,078 | +0.0% |
| New Jersey | $20 | $127 | 22 | 16,850 | +0.0% |
| New York | $20 | $142 | 161 | 9,460 | +0.0% |
| South Carolina | $20 | $105 | 45 | 911 | +0.0% |
| Arizona | $20 | $149 | 7 | 3,532 | +0.0% |
| California | $20 | $105 | 128 | 27,061 | +0.0% |
| Florida | $20 | $116 | 47 | 13,682 | 0.0% |
| Nevada | $20 | $128 | 48 | 1,172 | 0.0% |
| Pennsylvania | $20 | $94 | 26 | 2,301 | 0.0% |
| North Carolina | $20 | $148 | 17 | 4,347 | -0.0% |
| Texas | $20 | $113 | 179 | 10,877 | -0.0% |
| Alabama | $20 | $97 | 38 | 1,874 | -0.0% |
| Hawaii | $20 | $61 | 2 | 782 | -0.1% |
| Ohio | $20 | $126 | 38 | 3,054 | -0.1% |
| Washington | $20 | $136 | 22 | 1,748 | -0.1% |
| Virginia | $20 | $119 | 75 | 2,088 | -0.2% |
| Maine | $20 | $41 | 17 | 262 | -0.2% |
| Utah | $20 | $69 | 35 | 473 | -0.2% |
| Puerto Rico | $20 | $23 | 145 | 535 | -0.3% |
| Tennessee | $20 | $90 | 34 | 864 | -0.5% |
| Iowa | $20 | $80 | 35 | 531 | -0.6% |
| North Dakota | $20 | $109 | 3 | 93 | -0.7% |
| Indiana | $20 | $182 | 9 | 98 | -0.8% |
| Wisconsin | $20 | $162 | 10 | 710 | -1.0% |
| Oregon | $20 | $113 | 36 | 370 | -1.1% |
| Mississippi | $20 | $117 | 19 | 658 | -3.0% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
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