85007

Microscopic examination for white blood cells with manual cell count

Medicare pricing data for 5,565 providers across 49 states

🤖AI Overview

This procedure has a 5.0x markup — hospitals charge $18.72 but Medicare allows only $3.71. Uninsured patients may face bills 5.0 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

Microscopic examination for white blood cells with manual cell count (HCPCS code 85007) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $3.71, but hospitals typically charge $18.72 — a 5.0x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$0.74

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $3.71, your out-of-pocket cost would be approximately $0.74. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$3.71
Average Hospital Charge
$18.72
Markup Ratio
5.0x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$18.72
Medicare Allowed$3.71
Medicare Payment$3.71

Hospitals charge 5.0x more than what Medicare allows for this procedure. Medicare actually pays $3.71 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$4$14413+0.3%
District of Columbia$4$14412+0.3%
Illinois$4$2630817,014+0.3%
Massachusetts$4$194555,426+0.3%
Minnesota$4$183642,992+0.3%
Missouri$4$18539,999+0.3%
Montana$4$1912137+0.3%
Nevada$4$124199+0.3%
New Jersey$4$172216,246+0.3%
New York$4$1644216,265+0.3%
North Carolina$4$231254,837+0.3%
Rhode Island$4$87931+0.3%
South Dakota$4$1948843+0.3%
Tennessee$4$13433,398+0.3%
Utah$4$1049469+0.3%
Wyoming$4$121023+0.3%
Arizona$4$182037,150+0.3%
California$4$1818019,811+0.3%
Connecticut$4$201981,455+0.3%
Florida$4$171597,1850.0%
Georgia$4$20591,7740.0%
Indiana$4$23619640.0%
Kansas$4$1813826,0570.0%
Louisiana$4$17108070.0%
Michigan$4$10199510.0%
Nebraska$4$61134,4710.0%
New Mexico$4$22163960.0%
Ohio$4$153043,3200.0%
Oklahoma$4$1593,2130.0%
Pennsylvania$4$18784,9740.0%
Texas$4$2280140,6640.0%
Virginia$4$132853,4300.0%
Washington$4$13473,3570.0%
Alabama$4$19491,5040.0%
Colorado$4$21921,4400.0%
Idaho$4$1310239-0.3%
Maine$4$782810-0.3%
Maryland$4$131772,345-0.3%
Mississippi$4$21191,516-0.3%
North Dakota$4$2419149-0.3%
South Carolina$4$1815391-0.5%
Arkansas$4$94096-0.5%
Oregon$4$1648356-0.8%
Wisconsin$4$372822,927-0.8%
Kentucky$4$74591-1.1%
Puerto Rico$4$419248-1.1%
New Hampshire$4$1113149-1.6%
Iowa$4$1547539-1.9%
Hawaii$4$117246-4.0%

⚠️ 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