Immunologic analysis for detection of tumor antigen, quantitative; ca 125
Medicare pricing data for 2,534 providers across 47 states
This procedure has a 6.5x markup — hospitals charge $131.29 but Medicare allows only $20.35. Uninsured patients may face bills 6.5 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 125 (HCPCS code 86304) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.35, but hospitals typically charge $131.29 — a 6.5x 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 $20.35, 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 6.5x more than what Medicare allows for this procedure. Medicare actually pays $20.35 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Georgia | $20 | $159 | 28 | 1,619 | +0.2% |
| Idaho | $20 | $70 | 6 | 33 | +0.2% |
| Kansas | $20 | $182 | 20 | 3,993 | +0.2% |
| Kentucky | $20 | $74 | 2 | 33 | +0.2% |
| Louisiana | $20 | $144 | 19 | 206 | +0.2% |
| Maine | $20 | $36 | 3 | 193 | +0.2% |
| Massachusetts | $20 | $177 | 52 | 1,507 | +0.2% |
| Nebraska | $20 | $61 | 11 | 540 | +0.2% |
| New Mexico | $20 | $99 | 9 | 774 | +0.2% |
| Rhode Island | $20 | $63 | 1 | 29 | +0.2% |
| South Dakota | $20 | $116 | 2 | 67 | +0.2% |
| Vermont | $20 | $55 | 2 | 62 | +0.2% |
| West Virginia | $20 | $54 | 11 | 71 | +0.2% |
| Wyoming | $20 | $170 | 7 | 98 | +0.2% |
| Florida | $20 | $130 | 50 | 16,617 | +0.1% |
| Maryland | $20 | $121 | 52 | 3,014 | +0.1% |
| Minnesota | $20 | $151 | 194 | 2,139 | +0.1% |
| Nevada | $20 | $157 | 39 | 1,089 | +0.1% |
| Pennsylvania | $20 | $144 | 24 | 2,850 | +0.1% |
| South Carolina | $20 | $87 | 37 | 1,417 | +0.1% |
| Ohio | $20 | $125 | 54 | 3,325 | +0.1% |
| Arizona | $20 | $152 | 35 | 6,203 | +0.1% |
| California | $20 | $132 | 160 | 25,871 | +0.1% |
| New Jersey | $20 | $137 | 25 | 15,721 | +0.0% |
| North Carolina | $20 | $140 | 53 | 6,261 | +0.0% |
| Illinois | $20 | $150 | 163 | 3,225 | 0.0% |
| Oregon | $20 | $103 | 65 | 1,702 | 0.0% |
| Utah | $20 | $102 | 43 | 521 | 0.0% |
| Alabama | $20 | $106 | 36 | 2,221 | 0.0% |
| Hawaii | $20 | $60 | 2 | 728 | -0.0% |
| New York | $20 | $145 | 226 | 9,844 | -0.0% |
| Texas | $20 | $134 | 281 | 13,656 | -0.0% |
| Colorado | $20 | $142 | 42 | 1,311 | -0.0% |
| Virginia | $20 | $105 | 129 | 2,799 | -0.1% |
| Tennessee | $20 | $79 | 104 | 2,780 | -0.2% |
| Arkansas | $20 | $66 | 46 | 1,308 | -0.2% |
| North Dakota | $20 | $129 | 9 | 201 | -0.3% |
| Iowa | $20 | $66 | 65 | 1,140 | -0.3% |
| Mississippi | $20 | $128 | 18 | 189 | -0.3% |
| Michigan | $20 | $79 | 31 | 683 | -0.4% |
| Oklahoma | $20 | $78 | 18 | 1,245 | -0.5% |
| Puerto Rico | $20 | $22 | 194 | 925 | -0.6% |
| Washington | $20 | $131 | 72 | 2,747 | -0.8% |
| Indiana | $20 | $115 | 51 | 817 | -1.0% |
| Connecticut | $20 | $118 | 6 | 173 | -1.2% |
| Wisconsin | $20 | $157 | 18 | 1,632 | -1.6% |
| Missouri | $20 | $290 | 9 | 41 | -2.3% |
⚠️ 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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