86787

Analysis for antibody to varicella-zoster virus (chicken pox)

Medicare pricing data for 671 providers across 38 states

🤖AI Overview

This procedure has a 8.7x markup — hospitals charge $109.59 but Medicare allows only $12.58. Uninsured patients may face bills 8.7 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 varicella-zoster virus (chicken pox) (HCPCS code 86787) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.58, but hospitals typically charge $109.59 — a 8.7x 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 $12.58, 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
$12.58
Average Hospital Charge
$109.59
Markup Ratio
8.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$109.59
Medicare Allowed$12.58
Medicare Payment$12.58

Hospitals charge 8.7x more than what Medicare allows for this procedure. Medicare actually pays $12.58 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$13$1443577+0.3%
Illinois$13$13242456+0.3%
Indiana$13$67148+0.3%
Iowa$13$35438+0.3%
Louisiana$13$75532+0.3%
Maryland$13$11720536+0.3%
Mississippi$13$99516+0.3%
New Mexico$13$65133+0.3%
New York$13$105942,913+0.3%
Oregon$13$508103+0.3%
Pennsylvania$13$10711370+0.3%
Rhode Island$13$51234+0.3%
South Carolina$13$35314+0.3%
Tennessee$13$873205+0.3%
Utah$13$26548+0.3%
Colorado$13$1046290+0.3%
Kansas$13$1316519+0.2%
Texas$13$101401,918+0.2%
North Carolina$13$94123,012+0.2%
Florida$13$137173,049+0.1%
Massachusetts$13$13361853+0.1%
California$13$110354,275+0.1%
Michigan$13$4110850.0%
Nevada$13$11521760.0%
Washington$13$93132600.0%
New Jersey$13$114567,811-0.1%
Ohio$13$8122869-0.1%
Alabama$13$977552-0.3%
Hawaii$13$55278-0.4%
Minnesota$13$12763550-0.4%
Oklahoma$13$1104118-0.4%
Puerto Rico$13$163773-0.4%
Arizona$13$994714-0.6%
Wisconsin$12$8913240-0.8%
Virginia$12$388243-1.5%
Connecticut$12$601431-1.5%
Maine$12$551141-1.6%
Kentucky$12$55353-5.0%

⚠️ 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