86665

Analysis for antibody to epstein-barr virus (mononucleosis virus), viral capsid

Medicare pricing data for 533 providers across 41 states

🤖AI Overview

This procedure has a 6.0x markup — hospitals charge $105.80 but Medicare allows only $17.73. Uninsured patients may face bills 6.0 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 epstein-barr virus (mononucleosis virus), viral capsid (HCPCS code 86665) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $17.73, but hospitals typically charge $105.80 — a 6.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $17.73, your out-of-pocket cost would be approximately $3.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$17.73
Average Hospital Charge
$105.80
Markup Ratio
6.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$105.80
Medicare Allowed$17.73
Medicare Payment$17.73

Hospitals charge 6.0x more than what Medicare allows for this procedure. Medicare actually pays $17.73 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$18$13311,343+0.3%
Kansas$18$12661,312+0.3%
Louisiana$18$6017142+0.3%
Maryland$18$1315563+0.3%
Massachusetts$18$126381,376+0.3%
Michigan$18$4710201+0.3%
New Mexico$18$1441135+0.3%
North Dakota$18$51337+0.3%
South Carolina$18$37347+0.3%
Tennessee$18$943591+0.3%
Colorado$18$1097384+0.3%
Nebraska$18$30150+0.2%
Rhode Island$18$39292+0.2%
Puerto Rico$18$211641+0.2%
New York$18$83416,910+0.2%
New Jersey$18$1034916,123+0.1%
Pennsylvania$18$1227819+0.1%
Texas$18$96525,616+0.1%
Washington$18$1268935+0.1%
California$18$118326,599+0.1%
Illinois$18$132201,3100.0%
North Carolina$18$102137,2640.0%
Florida$18$135205,733-0.1%
Oklahoma$18$985405-0.2%
Arizona$18$9753,078-0.2%
Nevada$18$1303315-0.3%
Ohio$18$93282,683-0.3%
Oregon$18$554244-0.4%
Hawaii$18$662300-0.6%
Alabama$18$11081,413-0.7%
Minnesota$18$14637398-0.9%
Wisconsin$17$1257317-1.9%
Kentucky$17$60294-2.0%
Missouri$17$841021-2.1%
Utah$17$2819155-2.5%
Iowa$17$59683-2.7%
South Dakota$17$81393-2.7%
Virginia$17$555320-3.3%
Connecticut$17$721354-4.1%
Indiana$17$89578-4.3%
Maine$17$78457-5.5%

⚠️ 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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