86225

Measurement of dna antibody, native or double stranded

Medicare pricing data for 2,348 providers across 46 states

🤖AI Overview

This procedure has a 6.9x markup — hospitals charge $93.08 but Medicare allows only $13.42. Uninsured patients may face bills 6.9 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

Measurement of dna antibody, native or double stranded (HCPCS code 86225) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $13.42, but hospitals typically charge $93.08 — a 6.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.68

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $13.42, your out-of-pocket cost would be approximately $2.68. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$13.42
Average Hospital Charge
$93.08
Markup Ratio
6.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$93.08
Medicare Allowed$13.42
Medicare Payment$13.42

Hospitals charge 6.9x more than what Medicare allows for this procedure. Medicare actually pays $13.42 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Massachusetts$13$1091483,330+0.4%
New Hampshire$13$531095+0.4%
Rhode Island$13$53494+0.4%
Wyoming$13$115130+0.4%
Connecticut$13$66212+0.4%
New Jersey$13$1049241,341+0.3%
New York$13$9518915,828+0.3%
Colorado$13$105111,682+0.3%
Florida$13$1037321,504+0.2%
Kansas$13$109385,113+0.2%
Nevada$13$11352,024+0.2%
California$13$8411043,356+0.2%
Utah$13$2832437+0.1%
Puerto Rico$13$15138433+0.1%
Hawaii$13$5021,5240.0%
New Mexico$13$4297610.0%
North Carolina$13$10110228,1330.0%
Arizona$13$769712,5120.0%
Ohio$13$853110,239-0.1%
Oregon$13$429527-0.1%
Pennsylvania$13$77404,121-0.1%
Texas$13$10418528,375-0.1%
Illinois$13$1101895,977-0.1%
South Dakota$13$846341-0.1%
Alabama$13$90398,809-0.1%
Idaho$13$5420495-0.2%
Maryland$13$79362,362-0.2%
Oklahoma$13$79453,171-0.2%
Tennessee$13$73432,997-0.3%
Michigan$13$36131,234-0.4%
Kentucky$13$44311,081-0.4%
Missouri$13$5046788-0.4%
Louisiana$13$6886998-0.5%
Minnesota$13$1001612,281-0.6%
Virginia$13$41142,017-0.6%
Georgia$13$111369,317-0.7%
Indiana$13$71251,132-0.7%
South Carolina$13$4641983-0.7%
Arkansas$13$49651,773-0.8%
Iowa$13$4237803-1.0%
Wisconsin$13$118271,858-1.1%
Nebraska$13$588414-1.7%
Maine$13$452154-2.2%
Washington$13$73173,316-3.5%
Mississippi$13$741482-3.9%
North Dakota$13$62978-6.6%

⚠️ 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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💊 Need post-procedure medications? Check costs on OpenPrescriber