86617

Confirmation test for antibody to borrelia burgdorferi (lyme disease bacteria)

Medicare pricing data for 492 providers across 37 states

🤖AI Overview

This procedure has a 7.4x markup — hospitals charge $112.34 but Medicare allows only $15.16. Uninsured patients may face bills 7.4 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

Confirmation test for antibody to borrelia burgdorferi (lyme disease bacteria) (HCPCS code 86617) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $15.16, but hospitals typically charge $112.34 — a 7.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.03

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $15.16, your out-of-pocket cost would be approximately $3.03. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$15.16
Average Hospital Charge
$112.34
Markup Ratio
7.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$112.34
Medicare Allowed$15.16
Medicare Payment$15.16

Hospitals charge 7.4x more than what Medicare allows for this procedure. Medicare actually pays $15.16 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$15$11431,537+0.1%
Hawaii$15$66232+0.1%
Illinois$15$11661,664+0.1%
Indiana$15$591109+0.1%
Iowa$15$43598+0.1%
Kansas$15$1164624+0.1%
Louisiana$15$39230+0.1%
Massachusetts$15$115307,679+0.1%
Michigan$15$38524+0.1%
New Hampshire$15$5927123+0.1%
Oklahoma$15$1184237+0.1%
Oregon$15$453146+0.1%
Rhode Island$15$361240+0.1%
South Dakota$15$98344+0.1%
Tennessee$15$1083344+0.1%
Utah$15$342180+0.1%
Washington$15$984151+0.1%
Alabama$15$895528+0.1%
Colorado$15$945103+0.1%
Florida$15$112104,641+0.1%
Maryland$15$10952,600+0.1%
New Jersey$15$1152272,958+0.1%
Pennsylvania$15$101103,255+0.1%
Texas$15$97141,604+0.1%
New York$15$15112410,9490.0%
Ohio$15$93118950.0%
North Carolina$15$911016,688-0.1%
California$15$108173,196-0.1%
Arizona$15$1094716-0.1%
Maine$15$588151-0.2%
Minnesota$15$13063566-0.2%
Connecticut$15$6834106-0.5%
Wisconsin$15$11316420-0.6%
Kentucky$15$553234-0.7%
Virginia$15$566881-0.7%
Nevada$15$112275-1.8%
South Carolina$14$41423-8.2%

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

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