99195

Drawing of blood for a medical problem

Medicare pricing data for 5,101 providers across 51 states

🤖AI Overview

Prices vary significantly by location — from $47 in Arizona to $119 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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

Drawing of blood for a medical problem (HCPCS code 99195) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $93.58, but hospitals typically charge $250.09 — a 2.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$18.72

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $93.58, your out-of-pocket cost would be approximately $18.72. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$93.58
Average Hospital Charge
$250.09
Markup Ratio
2.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$250.09
Medicare Allowed$93.58
Medicare Payment$67.65

Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $67.65 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$119$281787+27.4%
New York$113$3483516,221+21.1%
California$111$28257711,145+18.4%
New Jersey$110$2661612,526+17.9%
Maryland$109$2691011,815+16.2%
Hawaii$107$16910284+14.3%
Connecticut$104$34130443+11.3%
Massachusetts$104$27550542+11.2%
New Hampshire$101$35114108+8.2%
Delaware$101$2824164+7.5%
Alaska$100$37729259+6.9%
Pennsylvania$99$2421061,492+5.8%
Colorado$99$25093723+5.5%
Vermont$98$1376117+4.3%
Puerto Rico$97$142924+4.1%
Virginia$97$2351252,517+3.1%
Nevada$96$255611,323+2.8%
Minnesota$96$342102540+2.7%
Maine$94$36415183+0.6%
Michigan$94$242931,158+0.5%
Montana$94$189532+0.1%
North Dakota$94$27913142-0.0%
Illinois$93$2291871,594-0.2%
Florida$93$2544538,035-0.3%
Wyoming$93$26327210-0.5%
Oregon$93$29882790-0.9%
Texas$93$2575746,760-1.1%
Washington$92$224115943-1.5%
South Dakota$91$2461973-2.4%
Wisconsin$90$34861343-4.3%
North Carolina$89$2331171,618-5.3%
Ohio$88$2421261,138-5.8%
Missouri$88$23793531-6.2%
Nebraska$87$18966517-6.7%
Indiana$87$20678794-6.9%
New Mexico$87$20051630-7.4%
South Carolina$87$20073914-7.4%
Kansas$86$18246513-7.7%
Georgia$85$2621041,247-8.8%
Iowa$85$30443378-9.1%
Utah$85$16358517-9.2%
Oklahoma$84$21248315-9.8%
Louisiana$84$21142639-10.1%
Tennessee$84$2371812,188-10.3%
Idaho$83$21827341-11.6%
Alabama$82$1741191,445-11.9%
Arkansas$81$295871,489-12.9%
Mississippi$78$22035601-17.1%
West Virginia$74$21521195-21.1%
Kentucky$70$15637527-24.8%
Arizona$47$1121635,722-49.5%

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

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