Detection test by nucleic acid for hiv-1 virus, quantification
Medicare pricing data for 419 providers across 40 states
This procedure has a 5.2x markup — hospitals charge $432.05 but Medicare allows only $83.28. Uninsured patients may face bills 5.2 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
Detection test by nucleic acid for hiv-1 virus, quantification (HCPCS code 87536) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $83.28, but hospitals typically charge $432.05 — a 5.2x 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 $83.28, your out-of-pocket cost would be approximately $16.66. 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 5.2x more than what Medicare allows for this procedure. Medicare actually pays $83.28 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Hawaii | $83 | $294 | 2 | 282 | +0.1% |
| Kansas | $83 | $428 | 3 | 2,010 | +0.1% |
| Louisiana | $83 | $496 | 1 | 146 | +0.1% |
| Massachusetts | $83 | $407 | 29 | 2,094 | +0.1% |
| New Mexico | $83 | $365 | 1 | 56 | +0.1% |
| Rhode Island | $83 | $170 | 1 | 15 | +0.1% |
| South Carolina | $83 | $178 | 5 | 32 | +0.1% |
| South Dakota | $83 | $476 | 4 | 83 | +0.1% |
| Utah | $83 | $185 | 3 | 61 | +0.1% |
| Wyoming | $83 | $449 | 2 | 39 | +0.1% |
| Colorado | $83 | $449 | 5 | 136 | +0.1% |
| Puerto Rico | $83 | $93 | 28 | 159 | +0.1% |
| Alabama | $83 | $496 | 3 | 2,190 | +0.1% |
| Ohio | $83 | $431 | 9 | 1,827 | +0.1% |
| Illinois | $83 | $416 | 11 | 1,720 | +0.1% |
| Texas | $83 | $454 | 25 | 7,319 | +0.1% |
| California | $83 | $407 | 51 | 16,145 | +0.1% |
| Georgia | $83 | $406 | 22 | 2,882 | +0.1% |
| New Jersey | $83 | $446 | 13 | 12,464 | +0.1% |
| Tennessee | $83 | $331 | 4 | 681 | +0.0% |
| Florida | $83 | $423 | 23 | 12,064 | +0.0% |
| North Carolina | $83 | $493 | 12 | 11,902 | -0.0% |
| Maryland | $83 | $362 | 6 | 2,896 | -0.0% |
| Virginia | $83 | $272 | 7 | 575 | -0.0% |
| Washington | $83 | $361 | 14 | 773 | -0.1% |
| Wisconsin | $83 | $339 | 6 | 384 | -0.1% |
| Michigan | $83 | $210 | 7 | 244 | -0.2% |
| Nevada | $83 | $400 | 3 | 446 | -0.2% |
| Pennsylvania | $83 | $407 | 8 | 849 | -0.2% |
| New York | $83 | $483 | 10 | 1,268 | -0.2% |
| Indiana | $83 | $610 | 3 | 217 | -0.2% |
| Arizona | $83 | $505 | 4 | 2,591 | -0.2% |
| Maine | $83 | $213 | 3 | 113 | -0.3% |
| Oregon | $82 | $292 | 5 | 298 | -1.0% |
| Oklahoma | $82 | $293 | 4 | 608 | -1.2% |
| Minnesota | $82 | $529 | 63 | 625 | -1.3% |
| Kentucky | $82 | $263 | 1 | 114 | -1.6% |
| Connecticut | $82 | $315 | 2 | 65 | -1.7% |
| Iowa | $82 | $283 | 3 | 95 | -1.8% |
| Idaho | $81 | $140 | 1 | 22 | -2.9% |
⚠️ 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