86318

Test for detection of infectious agent antibody, qualitative or semiquantitative

Medicare pricing data for 2,137 providers across 36 states

🤖AI Overview

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

Test for detection of infectious agent antibody, qualitative or semiquantitative (HCPCS code 86318) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $17.59, but hospitals typically charge $53.72 — a 3.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.52

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $17.59, your out-of-pocket cost would be approximately $3.52. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$17.59
Average Hospital Charge
$53.72
Markup Ratio
3.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$53.72
Medicare Allowed$17.59
Medicare Payment$17.59

Hospitals charge 3.1x more than what Medicare allows for this procedure. Medicare actually pays $17.59 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Indiana$18$3560134+0.8%
Minnesota$18$45712+0.8%
Missouri$18$9775198+0.8%
Montana$18$341125+0.8%
Nebraska$18$49613+0.8%
New Jersey$18$217487+0.8%
New Mexico$18$341482+0.8%
Utah$18$342127+0.8%
Virginia$18$483495+0.8%
Washington$18$39735+0.8%
Wisconsin$18$62919+0.8%
Colorado$18$361457+0.8%
West Virginia$18$50819+0.7%
California$18$55533,753+0.7%
Illinois$18$7091542+0.6%
Pennsylvania$18$28745+0.4%
Oklahoma$18$4456129+0.2%
North Carolina$18$48133445+0.2%
Mississippi$18$50225786+0.1%
Texas$18$96191596+0.1%
Georgia$18$53179412-0.1%
Louisiana$18$41112519-0.3%
Arkansas$18$35190678-0.5%
Alabama$17$31191712-0.7%
Kentucky$17$3434165-0.9%
South Carolina$17$4970161-0.9%
Florida$17$5056226-1.2%
Idaho$17$322849-1.3%
Iowa$17$731726-1.4%
Tennessee$17$4573187-1.8%
Oregon$17$312552-2.0%
Michigan$17$341444-3.6%
Kansas$17$503977-3.8%
New York$17$4829231-3.8%
Ohio$16$401639-9.1%
Maryland$16$33512-9.9%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber