Analysis for antibody to virus
Medicare pricing data for 198 providers across 28 states
This procedure has a 8.4x markup — hospitals charge $105.58 but Medicare allows only $12.60. Uninsured patients may face bills 8.4 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 virus (HCPCS code 86790) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.60, but hospitals typically charge $105.58 — a 8.4x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
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.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 8.4x 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
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Minnesota | $13 | $82 | 4 | 248 | +0.5% |
| Arizona | $13 | $138 | 3 | 131 | +0.2% |
| Georgia | $13 | $127 | 1 | 92 | +0.2% |
| Illinois | $13 | $107 | 4 | 168 | +0.2% |
| Kansas | $13 | $126 | 4 | 61 | +0.2% |
| Maryland | $13 | $94 | 34 | 178 | +0.2% |
| Massachusetts | $13 | $104 | 3 | 231 | +0.2% |
| Missouri | $13 | $319 | 2 | 55 | +0.2% |
| New York | $13 | $115 | 9 | 384 | +0.2% |
| North Carolina | $13 | $149 | 8 | 433 | +0.2% |
| Ohio | $13 | $134 | 8 | 153 | +0.2% |
| Oklahoma | $13 | $130 | 3 | 33 | +0.2% |
| Oregon | $13 | $106 | 4 | 21 | +0.2% |
| Pennsylvania | $13 | $172 | 5 | 80 | +0.2% |
| Tennessee | $13 | $95 | 1 | 18 | +0.2% |
| Utah | $13 | $32 | 4 | 48 | +0.2% |
| Virginia | $13 | $66 | 4 | 44 | +0.2% |
| Washington | $13 | $110 | 5 | 67 | +0.2% |
| Wisconsin | $13 | $122 | 4 | 37 | +0.2% |
| Puerto Rico | $13 | $18 | 15 | 34 | +0.2% |
| Alabama | $13 | $121 | 4 | 27 | +0.2% |
| Colorado | $13 | $124 | 3 | 38 | +0.2% |
| Florida | $13 | $104 | 8 | 1,155 | 0.0% |
| New Jersey | $13 | $96 | 8 | 2,405 | 0.0% |
| Texas | $13 | $109 | 12 | 535 | 0.0% |
| California | $13 | $92 | 17 | 1,160 | -0.2% |
| Hawaii | $12 | $84 | 2 | 30 | -1.7% |
| Nevada | $12 | $118 | 1 | 20 | -3.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber