86735

Analysis for antibody to mumps virus

Medicare pricing data for 462 providers across 33 states

🤖AI Overview

This procedure has a 8.1x markup — hospitals charge $102.79 but Medicare allows only $12.75. Uninsured patients may face bills 8.1 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 to mumps virus (HCPCS code 86735) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.75, but hospitals typically charge $102.79 — a 8.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $12.75, your out-of-pocket cost would be approximately $2.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$12.75
Average Hospital Charge
$102.79
Markup Ratio
8.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$102.79
Medicare Allowed$12.75
Medicare Payment$12.75

Hospitals charge 8.1x more than what Medicare allows for this procedure. Medicare actually pays $12.75 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$13$1362120+0.3%
Indiana$13$111121+0.3%
Kansas$13$1255194+0.3%
Maryland$13$11314211+0.3%
Massachusetts$13$12251467+0.3%
Nevada$13$102268+0.3%
New Mexico$13$37111+0.3%
New York$13$105832,116+0.3%
Oklahoma$13$113332+0.3%
Oregon$13$50523+0.3%
Pennsylvania$13$9110214+0.3%
Rhode Island$13$39213+0.3%
South Dakota$13$79211+0.3%
Tennessee$13$73334+0.3%
Texas$13$10225447+0.3%
Utah$13$28211+0.3%
Washington$13$647110+0.3%
Alabama$13$82372+0.3%
Arizona$13$984166+0.3%
Colorado$13$97673+0.3%
Connecticut$13$701219+0.3%
California$13$103352,661+0.2%
Florida$13$12412436-0.2%
New Jersey$13$105545,417-0.2%
North Carolina$13$856933-0.2%
Ohio$13$7716242-0.5%
Illinois$13$10919214-0.6%
Hawaii$13$36250-0.9%
Minnesota$13$14116142-0.9%
Michigan$13$47623-1.6%
Wisconsin$13$951092-1.6%
Virginia$13$46699-1.6%
Maine$12$511027-2.7%

⚠️ 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