86765

Analysis for antibody to rubeola (measles virus)

Medicare pricing data for 461 providers across 33 states

🤖AI Overview

This procedure has a 8.0x markup — hospitals charge $100.97 but Medicare allows only $12.60. Uninsured patients may face bills 8.0 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 rubeola (measles virus) (HCPCS code 86765) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.60, but hospitals typically charge $100.97 — a 8.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.52

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $12.60, your out-of-pocket cost would be approximately $2.52. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$12.60
Average Hospital Charge
$100.97
Markup Ratio
8.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$100.97
Medicare Allowed$12.60
Medicare Payment$12.60

Hospitals charge 8.0x more than what Medicare allows for this procedure. Medicare actually pays $12.60 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$13$1392103+0.2%
Illinois$13$11219196+0.2%
Indiana$13$75114+0.2%
Kansas$13$1265236+0.2%
Maryland$13$11714226+0.2%
Massachusetts$13$11951503+0.2%
Nevada$13$107358+0.2%
New Mexico$13$72111+0.2%
New York$13$95792,198+0.2%
Oklahoma$13$101331+0.2%
Oregon$13$44518+0.2%
Pennsylvania$13$10110215+0.2%
Rhode Island$13$43216+0.2%
South Dakota$13$83211+0.2%
Tennessee$13$72382+0.2%
Texas$13$11223421+0.2%
Washington$13$668110+0.2%
Puerto Rico$13$15611+0.2%
Alabama$13$83367+0.2%
Colorado$13$96572+0.2%
Connecticut$13$571222+0.2%
New Jersey$13$105535,413+0.1%
California$13$97403,527+0.1%
North Carolina$13$8771,041-0.2%
Arizona$13$954171-0.2%
Florida$13$13912462-0.3%
Wisconsin$13$1041093-0.8%
Ohio$12$7716243-1.0%
Minnesota$12$13419147-1.1%
Virginia$12$326104-1.7%
Maine$12$501030-2.5%
Hawaii$12$50236-3.5%
Michigan$12$44524-5.4%

⚠️ 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