86381

Measurement of mitochondrial antibody

Medicare pricing data for 303 providers across 38 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

Measurement of mitochondrial antibody (HCPCS code 86381) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $24.88, but hospitals typically charge $124.06 — a 5.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.98

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $24.88, your out-of-pocket cost would be approximately $4.98. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$24.88
Average Hospital Charge
$124.06
Markup Ratio
5.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$124.06
Medicare Allowed$24.88
Medicare Payment$24.88

Hospitals charge 5.0x more than what Medicare allows for this procedure. Medicare actually pays $24.88 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$25$13221,797+0.2%
Indiana$25$108280+0.2%
Kansas$25$12671,105+0.2%
Louisiana$25$119114+0.2%
Maine$25$63247+0.2%
New Hampshire$25$41712+0.2%
New Mexico$25$84196+0.2%
North Dakota$25$88119+0.2%
Oklahoma$25$1225467+0.2%
Oregon$25$54476+0.2%
Pennsylvania$25$1794704+0.2%
South Dakota$25$87364+0.2%
Puerto Rico$25$25529+0.2%
Colorado$25$1276527+0.2%
Florida$25$14185,502+0.2%
New Jersey$25$12997,719+0.2%
Texas$25$118286,970+0.2%
Alabama$25$12332,126+0.2%
Massachusetts$25$15651,344+0.2%
Nevada$25$1351476+0.2%
North Carolina$25$125109,247+0.1%
Arizona$25$11333,576+0.0%
California$25$129216,303+0.0%
Illinois$25$13058200.0%
Tennessee$25$822426-0.1%
Utah$25$5811124-0.1%
Maryland$25$1174797-0.2%
New York$25$9281,244-0.3%
Hawaii$25$542239-0.4%
Minnesota$25$12069745-0.4%
Washington$25$11716964-0.4%
Ohio$25$113112,226-0.8%
Wisconsin$25$867492-1.3%
Iowa$24$666146-2.0%
South Carolina$24$50220-2.4%
Michigan$24$103647-3.3%
Mississippi$24$83349-4.0%
Virginia$23$515483-8.7%

⚠️ 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