86618

Analysis for antibody borrelia burgdorferi (lyme disease bacteria)

Medicare pricing data for 3,095 providers across 45 states

🤖AI Overview

This procedure has a 8.1x markup — hospitals charge $134.18 but Medicare allows only $16.66. Uninsured patients may face bills 8.1 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

Analysis for antibody borrelia burgdorferi (lyme disease bacteria) (HCPCS code 86618) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $16.66, but hospitals typically charge $134.18 — a 8.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.33

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $16.66, your out-of-pocket cost would be approximately $3.33. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$16.66
Average Hospital Charge
$134.18
Markup Ratio
8.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$134.18
Medicare Allowed$16.66
Medicare Payment$16.66

Hospitals charge 8.1x more than what Medicare allows for this procedure. Medicare actually pays $16.66 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Delaware$17$31946+0.2%
Florida$17$182275,335+0.2%
Georgia$17$18372,368+0.2%
Hawaii$17$91252+0.2%
Missouri$17$102911+0.2%
Nebraska$17$52230+0.2%
New Mexico$17$89141+0.2%
Oregon$17$73493+0.2%
Rhode Island$17$375822+0.2%
South Dakota$17$806146+0.2%
Utah$17$47328+0.2%
Vermont$17$5812103+0.2%
Washington$17$15410231+0.2%
Arizona$17$1365482+0.2%
Arkansas$17$61722+0.2%
Colorado$17$1434180+0.2%
Kansas$17$17771,757+0.1%
Massachusetts$17$17144814,996+0.1%
Maryland$17$141855,398+0.1%
New Jersey$17$14728455,284+0.1%
New York$17$8981031,502+0.1%
North Carolina$17$1411715,336+0.1%
Tennessee$17$14619820+0.1%
Texas$17$172162,418+0.1%
Illinois$17$184161,3500.0%
Pennsylvania$17$118507,3100.0%
New Hampshire$17$5689318-0.1%
Ohio$17$127813,308-0.1%
Oklahoma$17$14110665-0.1%
California$17$159356,758-0.1%
Kentucky$17$566282-0.1%
Alabama$17$137121,113-0.2%
Connecticut$17$46129578-0.2%
Nevada$17$1813159-0.3%
Virginia$17$57561,839-0.4%
Minnesota$17$955202,209-0.5%
Maine$17$42126933-0.5%
Indiana$17$435228-0.7%
Mississippi$17$117869-0.7%
Iowa$17$6110527-0.9%
Wisconsin$16$115872,060-1.0%
South Carolina$16$427101-1.1%
Michigan$16$4612202-1.6%
West Virginia$16$1121435-2.7%
North Dakota$16$61524-6.6%

⚠️ 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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