86606

Analysis for antibody to aspergillus (fungus)

Medicare pricing data for 175 providers across 32 states

🤖AI Overview

This procedure has a 5.4x markup — hospitals charge $78.72 but Medicare allows only $14.63. Uninsured patients may face bills 5.4 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 antibody to aspergillus (fungus) (HCPCS code 86606) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $14.63, but hospitals typically charge $78.72 — a 5.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.93

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $14.63, your out-of-pocket cost would be approximately $2.93. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$14.63
Average Hospital Charge
$78.72
Markup Ratio
5.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$78.72
Medicare Allowed$14.63
Medicare Payment$14.63

Hospitals charge 5.4x more than what Medicare allows for this procedure. Medicare actually pays $14.63 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$15$562579+0.8%
Hawaii$15$652144+0.8%
Illinois$15$504258+0.8%
Indiana$15$482102+0.8%
Kansas$15$534540+0.8%
Kentucky$15$452102+0.8%
Maryland$15$525204+0.8%
Minnesota$15$955181+0.8%
Nevada$15$452511+0.8%
New Mexico$15$38153+0.8%
Oklahoma$15$444156+0.8%
Pennsylvania$15$477141+0.8%
Tennessee$15$84294+0.8%
Utah$15$304431+0.8%
Puerto Rico$15$16816+0.8%
Alabama$15$1282132+0.8%
Colorado$15$121561+0.8%
Florida$15$747935+0.8%
Arizona$15$664576+0.7%
North Carolina$15$13653,200+0.5%
New Jersey$15$8761,439+0.3%
South Carolina$15$48212+0.2%
Wisconsin$15$8142450.0%
Texas$15$60121,532-0.1%
South Dakota$15$52288-0.1%
Ohio$15$7310351-0.2%
Washington$15$945315-0.5%
California$15$65192,883-0.5%
Massachusetts$15$663219-0.7%
New York$15$7071,002-0.8%
Oregon$14$443100-6.9%
Virginia$13$365267-8.6%

⚠️ 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