Analysis for antibody to actinomyces (bacteria)
Medicare pricing data for 38 providers across 13 states
This procedure has a 7.6x markup — hospitals charge $75.54 but Medicare allows only $9.94. Uninsured patients may face bills 7.6 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
Analysis for antibody to actinomyces (bacteria) (HCPCS code 86602) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.94, but hospitals typically charge $75.54 — a 7.6x 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 $9.94, your out-of-pocket cost would be approximately $1.99. 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 7.6x more than what Medicare allows for this procedure. Medicare actually pays $9.94 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Florida | $10 | $76 | 2 | 182 | +0.4% |
| Kansas | $10 | $71 | 3 | 54 | +0.4% |
| New Jersey | $10 | $77 | 2 | 594 | +0.4% |
| Ohio | $10 | $73 | 3 | 188 | +0.4% |
| Tennessee | $10 | $77 | 1 | 62 | +0.4% |
| Texas | $10 | $77 | 3 | 232 | +0.4% |
| Washington | $10 | $77 | 2 | 340 | +0.4% |
| Alabama | $10 | $77 | 1 | 176 | +0.4% |
| Arizona | $10 | $76 | 2 | 211 | +0.4% |
| California | $10 | $85 | 2 | 250 | +0.4% |
| Colorado | $10 | $76 | 2 | 67 | +0.4% |
| North Carolina | $10 | $76 | 2 | 3,332 | +0.2% |
| Virginia | $8 | $8 | 1 | 69 | -24.1% |
⚠️ 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