86645

Analysis for antibody (igm) to cytomegalovirus (cmv)

Medicare pricing data for 294 providers across 36 states

🤖AI Overview

This procedure has a 7.1x markup — hospitals charge $117.60 but Medicare allows only $16.45. Uninsured patients may face bills 7.1 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 (igm) to cytomegalovirus (cmv) (HCPCS code 86645) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $16.45, but hospitals typically charge $117.60 — a 7.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.29

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $16.45, your out-of-pocket cost would be approximately $3.29. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$16.45
Average Hospital Charge
$117.60
Markup Ratio
7.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$117.60
Medicare Allowed$16.45
Medicare Payment$16.45

Hospitals charge 7.1x more than what Medicare allows for this procedure. Medicare actually pays $16.45 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$17$1831264+0.4%
Hawaii$17$51250+0.4%
Illinois$17$16422229+0.4%
Kentucky$17$52418+0.4%
Maryland$17$1345118+0.4%
Massachusetts$17$11623270+0.4%
Nebraska$17$50114+0.4%
Nevada$17$144273+0.4%
New Mexico$17$129125+0.4%
Ohio$17$10910436+0.4%
Oklahoma$17$100382+0.4%
South Dakota$17$86236+0.4%
Tennessee$17$100295+0.4%
Utah$17$33422+0.4%
Washington$17$1217152+0.4%
Puerto Rico$17$201325+0.4%
Colorado$17$138458+0.4%
Florida$16$178111,438+0.2%
New Jersey$16$100103,830+0.2%
Kansas$16$1294260+0.2%
North Carolina$16$109101,414+0.2%
California$16$118241,521+0.2%
New York$16$1199662+0.1%
Texas$16$9412991+0.1%
Alabama$16$1135259-0.7%
Arizona$16$1235838-0.9%
Michigan$16$60758-0.9%
Minnesota$16$16521366-1.0%
Oregon$16$42363-1.1%
Virginia$16$517117-1.1%
Wisconsin$16$1026112-1.4%
Louisiana$16$501729-1.6%
Pennsylvania$16$1127172-2.1%
Iowa$16$65331-2.2%
Indiana$16$72932-5.7%
Maine$13$81112-20.4%

⚠️ 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