U0005

Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within

Medicare pricing data for 4,024 providers across 48 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 1.5 million services annually. Even small pricing inefficiencies here affect millions of patients. 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

Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within (HCPCS code U0005) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $24.49, but hospitals typically charge $63.31 — a 2.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.90

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $24.49, your out-of-pocket cost would be approximately $4.90. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$24.49
Average Hospital Charge
$63.31
Markup Ratio
2.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$63.31
Medicare Allowed$24.49
Medicare Payment$24.49

Hospitals charge 2.6x more than what Medicare allows for this procedure. Medicare actually pays $24.49 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Virginia$25$483913,201+0.1%
Delaware$25$3159,052+0.0%
District of Columbia$25$59219+0.0%
Georgia$25$37487,223+0.0%
Illinois$25$81344356,589+0.0%
Indiana$25$36143,794+0.0%
Kansas$25$43134,402+0.0%
Louisiana$25$591735,194+0.0%
Maine$25$2631,014+0.0%
Massachusetts$25$384276,273+0.0%
Michigan$25$48357,188+0.0%
Mississippi$25$34124,557+0.0%
Missouri$25$451310,982+0.0%
Montana$25$26323+0.0%
Nevada$25$631110,086+0.0%
New Mexico$25$396545+0.0%
New York$25$7354661,079+0.0%
North Carolina$25$448397,044+0.0%
Oklahoma$25$962010,350+0.0%
Pennsylvania$25$323525,213+0.0%
Rhode Island$25$554400+0.0%
South Carolina$25$451514,078+0.0%
West Virginia$25$734153+0.0%
Puerto Rico$25$59353+0.0%
Alaska$25$60873+0.0%
Arkansas$25$6071,604+0.0%
California$25$67194469,451+0.0%
Colorado$25$60176,270+0.0%
Connecticut$25$41582,345+0.0%
Hawaii$24$2521,3480.0%
New Jersey$24$55246130,3740.0%
Ohio$24$37219,8180.0%
Alabama$24$402513,4380.0%
Arizona$24$391616,1790.0%
Florida$24$5714229,908-0.0%
Maryland$24$487214,327-0.0%
Oregon$24$27737,095-0.0%
Texas$24$5417660,398-0.0%
Kentucky$24$38516,808-0.1%
Tennessee$24$3612911,411-0.1%
Utah$24$4394,255-0.1%
New Hampshire$24$3018393-0.2%
Washington$24$413679,172-0.4%
Iowa$24$655392-0.7%
Nebraska$24$252255-0.7%
Wisconsin$24$58368,602-0.7%
Minnesota$24$346344,471-1.4%
Vermont$23$25118-5.5%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber