Insertion Of Needle Into Vein For Collection Of Blood Sample

Medicare Payment (avg)
$8.18
What Medicare actually pays
Billed Charge (avg)
$19.17
What providers submit
Markup
2.3x
134% above Medicare rate
40.5M
Total Services
15.1M
Beneficiaries
160.1K
Providers
54
States with Data

Price Range Across States

Lowest State Avg
$6.20
Puerto Rico
Highest State Avg
$8.39
Rhode Island

What You Might Pay

Est. Commercial Insurance
$18.32
Range: $12.82 – $25.65
Est. Cash / Self-Pay
$11.41
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Cardiovascular Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Rhode Island $8.39 $15.35
Wisconsin $8.33 $26.86
Massachusetts $8.33 $22.96
North Dakota $8.32 $18.82
North Carolina $8.32 $22.28
Georgia $8.32 $21.80
Guam $8.31 $15.43
Indiana $8.31 $14.13
Vermont $8.30 $18.76
Minnesota $8.29 $20.26
Ohio $8.28 $16.63
Nevada $8.28 $22.64
Maryland $8.27 $19.54
California $8.26 $21.13
Tennessee $8.26 $16.76
Alaska $8.26 $37.32
Iowa $8.25 $13.70
Connecticut $8.24 $17.90
Pennsylvania $8.23 $20.09
New Jersey $8.23 $23.92
New Mexico $8.22 $14.51
Kansas $8.22 $21.56
Texas $8.19 $18.42
West Virginia $8.19 $16.50
Illinois $8.19 $21.25
New York $8.18 $19.28
Arizona $8.16 $15.65
Maine $8.15 $11.24
Missouri $8.15 $16.81
Colorado $8.14 $20.10
Mississippi $8.13 $18.55
Hawaii $8.12 $8.83
Kentucky $8.11 $14.72
Washington $8.11 $18.55
Idaho $8.11 $13.95
Florida $8.10 $18.55
District of Columbia $8.10 $13.80
Utah $8.09 $13.46
South Carolina $8.05 $16.33
Arkansas $8.04 $13.45
Louisiana $8.01 $12.50
Alabama $7.98 $17.68
Oregon $7.98 $14.32
Virginia $7.98 $15.76
Wyoming $7.92 $18.23
Montana $7.92 $13.20
Michigan $7.80 $12.34
Oklahoma $7.74 $13.26
Delaware $7.61 $13.91
New Hampshire $7.57 $15.06
South Dakota $7.52 $14.21
Nebraska $7.46 $12.27
U.S. Virgin Islands $6.50 $14.09
Puerto Rico $6.20 $6.68

What the Data Says About Insertion Of Needle Into Vein For Collection Of Blood Sample

Across 54 states with reporting providers, CPT code 36415 (Insertion Of Needle Into Vein For Collection Of Blood Sample) shows a national average Medicare payment of $8.18 against an average billed charge of $19.17. That gap — a 2.3x markup, or 134% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Cardiovascular Surgery procedures like this one saw 40.5M services billed to Medicare in 2023 by 160.1K distinct providers, serving 15.1M unique beneficiaries. State-level variation is significant: Puerto Rico reports the lowest average payment at $6.20, while Rhode Island reports the highest at $8.39. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Cardiovascular Surgery category (2.24x), the estimated commercial insurance price lands near $18.32, with self-pay cash discounts commonly bringing the figure closer to $11.41. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Insertion Of Needle Into Vein For Collection Of Blood Sample cost?

The national average Medicare payment for Insertion Of Needle Into Vein For Collection Of Blood Sample (CPT 36415) is $8.18, while providers typically bill $19.17. Prices vary significantly by state, ranging from $6.20 to $8.39.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Insertion Of Needle Into Vein For Collection Of Blood Sample cost with insurance?

With commercial insurance, Insertion Of Needle Into Vein For Collection Of Blood Sample costs an estimated $18.32 on average (range: $12.82 – $25.65). Without insurance, the estimated cash price is $11.41. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Insertion Of Needle Into Vein For Collection Of Blood Sample?

Puerto Rico has the lowest average Medicare payment for Insertion Of Needle Into Vein For Collection Of Blood Sample at $6.20, while Rhode Island has the highest at $8.39. This $2.19 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Insertion Of Needle Into Vein For Collection Of Blood Sample?

Nationally, 160.1K providers billed Medicare for Insertion Of Needle Into Vein For Collection Of Blood Sample in 2023, performing 40.5M total services for 15.1M beneficiaries across 54 states and territories.

What is the billed-to-Medicare markup for Insertion Of Needle Into Vein For Collection Of Blood Sample?

Providers bill 2.3x what Medicare pays for Insertion Of Needle Into Vein For Collection Of Blood Sample — a 134% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial