Analysis for detection of tumor marker
Medicare pricing data for 447 providers across 34 states
This procedure has a 7.7x markup — hospitals charge $157.40 but Medicare allows only $20.36. Uninsured patients may face bills 7.7 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
Analysis for detection of tumor marker (HCPCS code 86316) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.36, but hospitals typically charge $157.40 — a 7.7x 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 $20.36, 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 7.7x more than what Medicare allows for this procedure. Medicare actually pays $20.36 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Georgia | $20 | $164 | 18 | 1,192 | +0.1% |
| Illinois | $20 | $131 | 11 | 824 | +0.1% |
| Indiana | $20 | $145 | 3 | 101 | +0.1% |
| Iowa | $20 | $81 | 4 | 125 | +0.1% |
| Kansas | $20 | $171 | 6 | 1,035 | +0.1% |
| Kentucky | $20 | $52 | 10 | 206 | +0.1% |
| New Mexico | $20 | $108 | 3 | 184 | +0.1% |
| New York | $20 | $267 | 7 | 266 | +0.1% |
| Oregon | $20 | $77 | 4 | 106 | +0.1% |
| Pennsylvania | $20 | $156 | 5 | 622 | +0.1% |
| South Carolina | $20 | $77 | 16 | 246 | +0.1% |
| Virginia | $20 | $84 | 5 | 132 | +0.1% |
| Wisconsin | $20 | $147 | 7 | 70 | +0.1% |
| Puerto Rico | $20 | $24 | 17 | 28 | +0.1% |
| Alabama | $20 | $176 | 5 | 368 | +0.1% |
| Florida | $20 | $142 | 11 | 3,301 | +0.1% |
| New Jersey | $20 | $156 | 9 | 5,721 | +0.1% |
| Arizona | $20 | $182 | 6 | 1,572 | +0.1% |
| North Carolina | $20 | $232 | 12 | 8,534 | +0.0% |
| California | $20 | $143 | 34 | 5,042 | +0.0% |
| Massachusetts | $20 | $84 | 20 | 1,203 | 0.0% |
| Utah | $20 | $43 | 2 | 555 | 0.0% |
| Nevada | $20 | $168 | 1 | 464 | -0.0% |
| Ohio | $20 | $83 | 45 | 1,650 | -0.0% |
| Texas | $20 | $149 | 65 | 3,288 | -0.0% |
| Minnesota | $20 | $237 | 7 | 401 | -0.1% |
| Maryland | $20 | $98 | 8 | 1,702 | -0.1% |
| Colorado | $20 | $158 | 17 | 574 | -0.1% |
| Oklahoma | $20 | $170 | 4 | 396 | -0.3% |
| Hawaii | $20 | $132 | 2 | 230 | -0.3% |
| Washington | $20 | $192 | 7 | 448 | -0.7% |
| Nebraska | $20 | $55 | 9 | 84 | -1.0% |
| Tennessee | $20 | $66 | 39 | 1,415 | -1.2% |
| Michigan | $19 | $168 | 4 | 34 | -5.5% |
⚠️ 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