95170

Professional service for preparation and provision of whole body extract of biting insect or arthropod antigens

Medicare pricing data for 275 providers across 8 states

🤖AI Overview

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

Professional service for preparation and provision of whole body extract of biting insect or arthropod antigens (HCPCS code 95170) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $10.70, but hospitals typically charge $33.09 — a 3.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.14

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $10.70, your out-of-pocket cost would be approximately $2.14. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$10.70
Average Hospital Charge
$33.09
Markup Ratio
3.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$33.09
Medicare Allowed$10.70
Medicare Payment$7.72

Hospitals charge 3.1x more than what Medicare allows for this procedure. Medicare actually pays $7.72 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$11$29551,631+4.5%
Texas$11$2626851+4.4%
Arizona$11$3213101+2.7%
Georgia$11$53291,006-0.4%
North Carolina$11$30612,031-0.6%
South Carolina$10$38301,403-3.4%
Alabama$10$367137-4.5%
Tennessee$10$3120464-5.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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