86757

Analysis for antibody to rickettsia (bacteria)

Medicare pricing data for 159 providers across 26 states

🤖AI Overview

This procedure has a 5.9x markup — hospitals charge $111.34 but Medicare allows only $18.94. Uninsured patients may face bills 5.9 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 rickettsia (bacteria) (HCPCS code 86757) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $18.94, but hospitals typically charge $111.34 — a 5.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.79

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $18.94, your out-of-pocket cost would be approximately $3.79. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$18.94
Average Hospital Charge
$111.34
Markup Ratio
5.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$111.34
Medicare Allowed$18.94
Medicare Payment$18.94

Hospitals charge 5.9x more than what Medicare allows for this procedure. Medicare actually pays $18.94 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Utah$19$39126+0.2%
Florida$19$1164403+0.1%
Georgia$19$10331,664+0.1%
Illinois$19$1022205+0.1%
Kansas$19$9461,886+0.1%
Maryland$19$973146+0.1%
Massachusetts$19$952312+0.1%
Minnesota$19$134244+0.1%
New York$19$7883,618+0.1%
South Carolina$19$67337+0.1%
Tennessee$19$1013950+0.1%
Virginia$19$305373+0.1%
Wisconsin$19$1024102+0.1%
Arizona$19$1413161+0.1%
Colorado$19$120332+0.1%
New Jersey$19$119118,425+0.1%
Texas$19$136101,0780.0%
North Carolina$19$135910,948-0.1%
Ohio$19$1408886-0.1%
Alabama$19$1297988-0.1%
California$19$84124,451-0.1%
Oklahoma$19$7471,061-0.2%
Kentucky$19$432129-0.6%
Mississippi$19$75285-2.2%
Arkansas$18$47937-2.6%
Pennsylvania$18$63689-3.3%

⚠️ 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