86258

Detection of gliadin (deamidated) (dgp) antibody

Medicare pricing data for 552 providers across 35 states

🤖AI Overview

This procedure has a 8.8x markup — hospitals charge $103.71 but Medicare allows only $11.79. Uninsured patients may face bills 8.8 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

Detection of gliadin (deamidated) (dgp) antibody (HCPCS code 86258) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.79, but hospitals typically charge $103.71 — a 8.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.36

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.79, your out-of-pocket cost would be approximately $2.36. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.79
Average Hospital Charge
$103.71
Markup Ratio
8.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$103.71
Medicare Allowed$11.79
Medicare Payment$11.79

Hospitals charge 8.8x more than what Medicare allows for this procedure. Medicare actually pays $11.79 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Mississippi$12$393121+5.9%
Florida$12$123103,939+0.2%
Georgia$12$12711,493+0.2%
Hawaii$12$77296+0.2%
Indiana$12$112232+0.2%
Iowa$12$565100+0.2%
Kansas$12$1268909+0.2%
Massachusetts$12$12252,089+0.2%
Michigan$12$976295+0.2%
Missouri$12$311124+0.2%
Nebraska$12$33293+0.2%
Nevada$12$1271170+0.2%
New Mexico$12$381693+0.2%
Oregon$12$503362+0.2%
South Carolina$12$31252+0.2%
Tennessee$12$814435+0.2%
Colorado$12$1176813+0.2%
Illinois$12$751191,602+0.1%
New Jersey$12$1153420,262+0.1%
New York$12$61395,369+0.1%
North Carolina$12$1091120,082+0.1%
Texas$12$132818,902+0.1%
Maryland$12$9068860.0%
Minnesota$12$131515540.0%
South Dakota$12$5125420.0%
Virginia$12$3779930.0%
Ohio$12$84103,917-0.1%
Washington$12$86203,752-0.1%
Pennsylvania$12$1128519-0.2%
Arizona$12$11644,809-0.2%
California$12$80208,059-0.2%
Utah$12$3637390-0.3%
Alabama$12$10733,450-0.3%
Oklahoma$12$814822-0.5%
Wisconsin$12$9411353-1.4%

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

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber