Genetic/Molecular Test · 83950

Her-2 Oncoprotein (cancer Related Gene) Measurement

What Medicare pays for 83950, what providers bill, and how the price varies across 3 states, drawn from CMS 2023 claims data.

83950 · the short answer

For her-2 oncoprotein (cancer related gene) measurement, Medicare pays about $63.12 while providers bill $389.57 on average, a 6.2× markup, an above-median markup. State-level Medicare rates range 0% from lowest to highest.

Medicare pays
$63.12
Providers bill
$389.57
Markup
6.2×
Markup percentile
63th

Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.

Medicare Payment (avg)
$63.12
What Medicare actually pays
Billed Charge (avg)
$389.57
What providers submit
Markup
6.2x
517% above Medicare rate
122
Total Services
86
Beneficiaries
10
Providers
3
States with Data

Price Range Across States

Lowest State Avg
$63.12
Ohio
Highest State Avg
$63.12
California

What You Might Pay

Est. Commercial Insurance
$141.39
Range: $98.97 – $197.94
Est. Cash / Self-Pay
$154.47
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: Genetic/Molecular Test 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.

Where this markup sits nationally

Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate

6 Among the most affordable more affordable than 63% of 8,901 procedures

1–2: 466 procedures (5%). Below this entry. 2–3: 681 procedures (8%). Below this entry. 3–4: 845 procedures (9%). Below this entry. 4–5: 1,308 procedures (15%). Below this entry. 5–6: 1,725 procedures (19%). Below this entry. 6–7: 1,217 procedures (14%). This entry sits in this band. 7–8: 801 procedures (9%). Above this entry. 8–9: 541 procedures (6%). Above this entry. 9–10: 351 procedures (4%). Above this entry. 10–11: 246 procedures (3%). Above this entry. 11–12: 151 procedures (2%). Above this entry. 12–13: 175 procedures (2%). Above this entry. 13–14: 140 procedures (2%). Above this entry. 14–15: 40 procedures (0%). Above this entry. 15–16: 39 procedures (0%). Above this entry. 16–17: 26 procedures (0%). Above this entry. 17–18: 25 procedures (0%). Above this entry. 18–19: 21 procedures (0%). Above this entry. 19–20: 12 procedures (0%). Above this entry. 20–21: 16 procedures (0%). Above this entry. 21–22: 13 procedures (0%). Above this entry. 22–23: 8 procedures (0%). Above this entry. 23–24: 9 procedures (0%). Above this entry. 24–25: 4 procedures (0%). Above this entry. 25–26: 3 procedures (0%). Above this entry. 26–27: 3 procedures (0%). Above this entry. 27–28: 4 procedures (0%). Above this entry. 28–29: 3 procedures (0%). Above this entry. 29–30: 2 procedures (0%). Above this entry. 30–31: 26 procedures (0%). Above this entry. this procedure 1 31 × markup, bucketed by value

Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Medicare Physician & Other Practitioners · 2023

Prices by State

State Medicare Payment Billed Charge
California $63.12 $392.42
North Carolina $63.12 $389.92
Ohio $63.12 $390.73

What the Data Says About Her-2 Oncoprotein (cancer Related Gene) Measurement

Across 3 states with reporting providers, CPT code 83950 (Her-2 Oncoprotein (cancer Related Gene) Measurement) shows a national average Medicare payment of $63.12 against an average billed charge of $389.57. That gap, a 6.2x markup, or 517% above the Medicare allowed amount, is roughly in line with what most procedures show, chargemaster pricing that no major payer pays in full but that still anchors negotiations.

Genetic/Molecular Test procedures like this one saw 122 services billed to Medicare in 2023 by 10 distinct providers, serving 86 unique beneficiaries. State-level variation is significant: Ohio reports the lowest average payment at $63.12, while California reports the highest at $63.12. At just 0%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Genetic/Molecular Test category (2.24x), the estimated commercial insurance price lands near $141.39, with self-pay cash discounts commonly bringing the figure closer to $154.47. Within Genetic/Molecular Test, Her-2 Oncoprotein (cancer Related Gene) Measurement ranks #240 of 298 tracked procedures by national average Medicare payment.

What to do with this

If you may have her-2 oncoprotein (cancer related gene) measurement done, these steps turn the numbers above into a real-world cost estimate.

  • Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
  • Compare her-2 oncoprotein (cancer related gene) measurement costs in your state, Medicare rates vary by locality. Browse states
  • Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
  • Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide

Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.

Frequently Asked Questions

How much does Her-2 Oncoprotein (cancer Related Gene) Measurement cost?

Her-2 Oncoprotein (cancer Related Gene) Measurement (CPT 83950) is priced fairly consistently nationwide: Medicare pays $63.12 on average, and the $63.12-$63.12 state range stays relatively tight. Providers typically bill $389.57.

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 Her-2 Oncoprotein (cancer Related Gene) Measurement cost with insurance?

With commercial insurance, her-2 oncoprotein (cancer related gene) measurement costs an estimated $141.39 on average (range: $98.97-$197.94), a moderate premium over Medicare's $63.12. Without insurance, the estimated cash price is $154.47.

Which state has the lowest cost for Her-2 Oncoprotein (cancer Related Gene) Measurement?

Ohio and California bookend the range for Her-2 Oncoprotein (cancer Related Gene) Measurement, at $63.12 and $63.12 respectively - a relatively tight $0.00 spread nationwide.

How many providers perform Her-2 Oncoprotein (cancer Related Gene) Measurement?

Her-2 Oncoprotein (cancer Related Gene) Measurement is comparatively uncommon: only 10 providers nationally billed Medicare for it in 2023, serving 86 beneficiaries via 122 total services.

What is the billed-to-Medicare markup for Her-2 Oncoprotein (cancer Related Gene) Measurement?

Providers bill 6.2x what Medicare pays for Her-2 Oncoprotein (cancer Related Gene) Measurement - an above-median markup at 517% above the Medicare rate.

Related Guides

Negotiating Your Medical Bill

Tips to reduce out-of-pocket costs
Hospital Price Transparency

Your right to upfront pricing
Understanding Medicare Costs

How Medicare payments work
How to Read a Medical Bill

Decode charges and codes
Hospital Markup Explained

Why bills exceed actual costs
Why Costs Vary by State

Geographic pricing factors

Data from CMS Medicare Physician & Other Practitioners (2023).

Read our methodology - how this data is sourced, computed, and verified.

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

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.