Phenytoin Level, Free
Price Range Across States
What You Might Pay
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: Laboratory 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 |
|---|---|---|
| Virginia | $13.48 | $73.42 |
| Alabama | $13.48 | $125.33 |
| Arizona | $13.48 | $84.39 |
| Colorado | $13.48 | $103.92 |
| Florida | $13.48 | $95.97 |
| Georgia | $13.48 | $86.87 |
| Illinois | $13.48 | $84.85 |
| Indiana | $13.48 | $103.66 |
| Kansas | $13.48 | $97.63 |
| Maryland | $13.48 | $83.83 |
| Michigan | $13.48 | $42.71 |
| Mississippi | $13.48 | $32.39 |
| Nevada | $13.48 | $46.38 |
| New Hampshire | $13.48 | $120.10 |
| North Carolina | $13.48 | $133.40 |
| Ohio | $13.48 | $107.68 |
| Oklahoma | $13.48 | $62.53 |
| Oregon | $13.48 | $66.26 |
| Pennsylvania | $13.48 | $118.54 |
| Tennessee | $13.48 | $46.78 |
| Texas | $13.48 | $107.50 |
| Utah | $13.48 | $28.65 |
| Washington | $13.48 | $123.51 |
| Wisconsin | $13.48 | $90.66 |
| New York | $13.48 | $101.43 |
| New Jersey | $13.47 | $113.98 |
| Minnesota | $13.41 | $126.02 |
| California | $13.40 | $81.39 |
| Massachusetts | $13.39 | $72.21 |
What the Data Says About Phenytoin Level, Free
Across 29 states with reporting providers, CPT code 80186 (Phenytoin Level, Free) shows a national average Medicare payment of $13.47 against an average billed charge of $100.77. That gap — a 7.5x markup, or 648% 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.
Laboratory procedures like this one saw 4.5K services billed to Medicare in 2023 by 199 distinct providers, serving 3.1K unique beneficiaries. State-level variation is significant: Massachusetts reports the lowest average payment at $13.39, while Virginia reports the highest at $13.48. 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 Laboratory category (2.24x), the estimated commercial insurance price lands near $30.16, with self-pay cash discounts commonly bringing the figure closer to $37.81. 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 Phenytoin Level, Free cost?
The national average Medicare payment for Phenytoin Level, Free (CPT 80186) is $13.47, while providers typically bill $100.77. Prices vary significantly by state, ranging from $13.39 to $13.48.
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 Phenytoin Level, Free cost with insurance?
With commercial insurance, Phenytoin Level, Free costs an estimated $30.16 on average (range: $21.12 – $42.23). Without insurance, the estimated cash price is $37.81. 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 Phenytoin Level, Free?
Massachusetts has the lowest average Medicare payment for Phenytoin Level, Free at $13.39, while Virginia has the highest at $13.48. This $0.09 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.
How many providers perform Phenytoin Level, Free?
Nationally, 199 providers billed Medicare for Phenytoin Level, Free in 2023, performing 4.5K total services for 3.1K beneficiaries across 29 states and territories.
What is the billed-to-Medicare markup for Phenytoin Level, Free?
Providers bill 7.5x what Medicare pays for Phenytoin Level, Free — a 648% 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 Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.