86635

Analysis for antibody to coccidioides (bacteria)

Medicare pricing data for 185 providers across 32 states

🤖AI Overview

This procedure has a 6.2x markup — hospitals charge $69.52 but Medicare allows only $11.20. Uninsured patients may face bills 6.2 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 to coccidioides (bacteria) (HCPCS code 86635) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $11.20, but hospitals typically charge $69.52 — a 6.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.24

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $11.20, your out-of-pocket cost would be approximately $2.24. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$11.20
Average Hospital Charge
$69.52
Markup Ratio
6.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$69.52
Medicare Allowed$11.20
Medicare Payment$11.20

Hospitals charge 6.2x more than what Medicare allows for this procedure. Medicare actually pays $11.20 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Georgia$11$932192+0.4%
Hawaii$11$472115+0.4%
Illinois$11$822202+0.4%
Indiana$11$46259+0.4%
Iowa$11$28275+0.4%
Kansas$11$854358+0.4%
Kentucky$11$36254+0.4%
Maryland$11$82443+0.4%
Massachusetts$11$78344+0.4%
Minnesota$11$7872,827+0.4%
New Mexico$11$451153+0.4%
New York$11$71345+0.4%
North Carolina$11$8531,271+0.4%
Oklahoma$11$714102+0.4%
Pennsylvania$11$77441+0.4%
South Carolina$11$64177+0.4%
South Dakota$11$65276+0.4%
Tennessee$11$94223+0.4%
Texas$11$79131,266+0.4%
Utah$11$273211+0.4%
Washington$11$725277+0.4%
Alabama$11$128128+0.4%
Colorado$11$89595+0.4%
Nevada$11$7641,328+0.2%
Oregon$11$223790.0%
Arizona$11$703055,3070.0%
California$11$633114,256-0.2%
Florida$11$1124205-0.6%
Wisconsin$11$697137-1.1%
Ohio$11$69872-1.9%
New Jersey$10$714291-8.1%
Virginia$10$29458-11.0%

⚠️ 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