Total Protein Level, Body Fluid
What Medicare pays for 84157, what providers bill, and how the price varies across 30 states, drawn from CMS 2023 claims data.
84157 · the short answer
For total protein level, body fluid, Medicare pays about $3.91 on average across 30 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $3.91
- Providers bill
- $40.27
- States with data
- 30
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
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 |
|---|---|---|
| Arizona | $3.92 | $45.14 |
| Kansas | $3.92 | $43.72 |
| South Dakota | $3.92 | $24.60 |
| Puerto Rico | $3.92 | $4.99 |
| Alabama | $3.92 | $38.68 |
| Georgia | $3.92 | $52.73 |
| Hawaii | $3.92 | $22.60 |
| Maine | $3.92 | $26.70 |
| Massachusetts | $3.92 | $34.37 |
| Nevada | $3.92 | $54.08 |
| New Jersey | $3.92 | $32.69 |
| New York | $3.92 | $31.43 |
| North Dakota | $3.92 | $46.77 |
| Oregon | $3.92 | $22.78 |
| Pennsylvania | $3.92 | $55.65 |
| Texas | $3.92 | $36.05 |
| Iowa | $3.92 | $23.08 |
| Maryland | $3.92 | $51.34 |
| Ohio | $3.92 | $36.01 |
| Tennessee | $3.92 | $33.09 |
| Utah | $3.92 | $8.35 |
| Wisconsin | $3.92 | $30.99 |
| Florida | $3.92 | $49.99 |
| Minnesota | $3.92 | $58.30 |
| California | $3.91 | $31.87 |
| North Carolina | $3.91 | $41.51 |
| Washington | $3.89 | $27.79 |
| Illinois | $3.85 | $48.38 |
| Virginia | $3.81 | $25.22 |
| Oklahoma | $3.68 | $42.32 |
What the Data Says About Total Protein Level, Body Fluid
Across 30 states with reporting providers, CPT code 84157 (Total Protein Level, Body Fluid) shows a national average Medicare payment of $3.91 against an average billed charge of $40.27. That gap, a 10.3x markup, or 929% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Laboratory procedures like this one saw 4.3K services billed to Medicare in 2023 by 177 distinct providers, serving 3.4K unique beneficiaries. State-level variation is significant: Oklahoma reports the lowest average payment at $3.68, while Arizona reports the highest at $3.92. At just 6%, 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 Laboratory category (2.24x), the estimated commercial insurance price lands near $8.77, with self-pay cash discounts commonly bringing the figure closer to $14.01. Within Laboratory, Total Protein Level, Body Fluid ranks #498 of 502 tracked procedures by national average Medicare payment.
What to do with this
If you may have total protein level, body fluid 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 total protein level, body fluid 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 Total Protein Level, Body Fluid cost?
Total Protein Level, Body Fluid (CPT 84157) is priced fairly consistently nationwide: Medicare pays $3.91 on average, and the $3.68-$3.92 state range stays relatively tight. Providers typically bill $40.27.
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 Total Protein Level, Body Fluid cost with insurance?
With commercial insurance, total protein level, body fluid costs an estimated $8.77 on average (range: $6.14-$12.27), a moderate premium over Medicare's $3.91. Without insurance, the estimated cash price is $14.01.
Which state has the lowest cost for Total Protein Level, Body Fluid?
Oklahoma and Arizona bookend the range for Total Protein Level, Body Fluid, at $3.68 and $3.92 respectively - a relatively tight $0.24 spread nationwide.
How many providers perform Total Protein Level, Body Fluid?
Total Protein Level, Body Fluid is comparatively uncommon: only 177 providers nationally billed Medicare for it in 2023, serving 3.4K beneficiaries via 4.3K total services.
What is the billed-to-Medicare markup for Total Protein Level, Body Fluid?
Providers bill 10.3x what Medicare pays for Total Protein Level, Body Fluid - a markup within the typical range at 929% above the Medicare rate.
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
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
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.