86337

Insulin antibody measurement

Medicare pricing data for 153 providers across 26 states

🤖AI Overview

This procedure has a 9.5x markup — hospitals charge $198.76 but Medicare allows only $20.95. Uninsured patients may face bills 9.5 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Insulin antibody measurement (HCPCS code 86337) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.95, but hospitals typically charge $198.76 — a 9.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.19

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $20.95, your out-of-pocket cost would be approximately $4.19. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$20.95
Average Hospital Charge
$198.76
Markup Ratio
9.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$198.76
Medicare Allowed$20.95
Medicare Payment$20.95

Hospitals charge 9.5x more than what Medicare allows for this procedure. Medicare actually pays $20.95 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$21$2232388+0.1%
Illinois$21$2381183+0.1%
Kansas$21$2204324+0.1%
Maryland$21$214591+0.1%
Massachusetts$21$2312283+0.1%
New Jersey$21$2025811+0.1%
Ohio$21$1679173+0.1%
Oklahoma$21$183348+0.1%
Oregon$21$80315+0.1%
Pennsylvania$21$221669+0.1%
Tennessee$21$91249+0.1%
Texas$21$1928605+0.1%
Utah$21$54547+0.1%
Virginia$21$84352+0.1%
Alabama$21$1784231+0.1%
Arizona$21$1934184+0.1%
Colorado$21$201382+0.1%
Florida$21$2167940+0.0%
California$21$190151,532+0.0%
North Carolina$21$1689698-0.0%
New York$21$2136145-0.1%
Minnesota$21$3186165-1.0%
Washington$21$190492-1.0%
Hawaii$21$145236-1.8%
Nevada$21$2192102-2.0%
Wisconsin$20$199327-3.6%

⚠️ 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