Analysis for antibody to enterovirus (gastrointestinal virus)
Medicare pricing data for 80 providers across 14 states
This procedure has a 5.2x markup — hospitals charge $58.13 but Medicare allows only $11.16. Uninsured patients may face bills 5.2 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 enterovirus (gastrointestinal virus) (HCPCS code 86658) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.16, but hospitals typically charge $58.13 — a 5.2x 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 $11.16, your out-of-pocket cost would be approximately $2.23. 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 5.2x more than what Medicare allows for this procedure. Medicare actually pays $11.16 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Florida | $13 | $62 | 5 | 67 | +14.4% |
| Georgia | $13 | $39 | 1 | 131 | +14.4% |
| Illinois | $13 | $46 | 2 | 68 | +14.4% |
| Kansas | $13 | $60 | 3 | 65 | +14.4% |
| Massachusetts | $13 | $42 | 3 | 191 | +14.4% |
| New York | $13 | $74 | 5 | 349 | +14.4% |
| North Carolina | $13 | $76 | 4 | 2,014 | +14.4% |
| Pennsylvania | $13 | $31 | 4 | 37 | +14.4% |
| Texas | $13 | $47 | 7 | 238 | +14.4% |
| Alabama | $13 | $70 | 1 | 345 | +14.4% |
| Arizona | $13 | $98 | 2 | 708 | +14.4% |
| California | $13 | $42 | 8 | 723 | +13.0% |
| Ohio | $12 | $60 | 5 | 177 | +9.2% |
| New Jersey | $8 | $39 | 5 | 3,017 | -24.9% |
⚠️ 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