Immunology · 86000
Measurement Of Antibody To Infectious Organism
What Medicare pays for 86000, what providers bill, and how the price varies across 7 states, drawn from CMS 2023 claims data.
- $6.82
- Medicare pays
- $125.28
- Providers bill
- 18.4×
- Markup
- #5,578 of 9,297
- Volume rank
The verdict
Measurement Of Antibody To Infectious Organism pairs modest national service volume with one of the steepest markups in the catalog.
- 40th pct.
- national service volume
- Top 1%
- billed-to-Medicare markup
- 18.4×
- billed vs. Medicare
- $6.82
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
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). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Immunology, the applied ratio is 1.85x Medicare (RAND 2024 Pathology and Laboratory bucket (1.85x) + CMS Medicare baseline). 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
18 Among the most affordable more affordable than 99% of 8,901 procedures
Each bar is a 1-wide 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
What the billed charge breaks down into
$125.28
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Kansas | $6.84 | $166.14 |
| Massachusetts | $6.84 | $170.38 |
| New Jersey | $6.84 | $168.39 |
| Tennessee | $6.84 | $125.00 |
| Arkansas | $6.84 | $25.00 |
| Oklahoma | $6.84 | $161.98 |
| North Carolina | $6.76 | $29.11 |
What the Data Says About Measurement Of Antibody To Infectious Organism
Across 7 states with reporting providers, CPT code 86000 (Measurement Of Antibody To Infectious Organism) shows a national average Medicare payment of $6.82 against an average billed charge of $125.28. That gap, a 18.4x markup, or 1737% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.
Immunology procedures like this one saw 597 services billed to Medicare in 2023 by 32 distinct providers, serving 570 unique beneficiaries. State-level variation is significant: North Carolina reports the lowest average payment at $6.76, while Kansas reports the highest at $6.84. At just 1%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code. Applying the RAND 2024 commercial-to-Medicare ratio for this category (1.85x Medicare; RAND 2024 Pathology and Laboratory bucket (1.85x) + CMS Medicare baseline), the estimated commercial insurance price lands near $12.62, with self-pay cash discounts commonly bringing the figure closer to $39.57. Within Immunology, Measurement Of Antibody To Infectious Organism ranks #219 of 225 tracked procedures by national average Medicare payment.
Where this sits in the registry
Measurement Of Antibody To Infectious Organism (86000) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Immunology codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Measurement Of Antibody To Infectious Organism rank among Medicare procedures?
According to CMS Medicare Part B claims, Measurement Of Antibody To Infectious Organism (CPT 86000) ranks #5,578 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #219 of 225 within Immunology by national average Medicare payment. See /methodology#corpus-placement.
How much does Measurement Of Antibody To Infectious Organism cost?
Measurement Of Antibody To Infectious Organism (CPT 86000) is priced fairly consistently nationwide: Medicare pays $6.82 on average, and the $6.76-$6.84 state range stays relatively tight. Providers typically bill $125.28.
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 Measurement Of Antibody To Infectious Organism cost with insurance?
With commercial insurance, measurement of antibody to infectious organism costs an estimated $12.62 on average (range: $8.83-$17.67), a moderate premium over Medicare's $6.82. Without insurance, the estimated cash price is $39.57.
Which state has the lowest cost for Measurement Of Antibody To Infectious Organism?
North Carolina and Kansas bookend the range for Measurement Of Antibody To Infectious Organism, at $6.76 and $6.84 respectively - a relatively tight $0.08 spread nationwide.
How many providers perform Measurement Of Antibody To Infectious Organism?
Measurement Of Antibody To Infectious Organism is comparatively uncommon: only 32 providers nationally billed Medicare for it in 2023, serving 570 beneficiaries via 597 total services.
What is the billed-to-Medicare markup for Measurement Of Antibody To Infectious Organism?
Providers bill 18.4x what Medicare pays for Measurement Of Antibody To Infectious Organism - one of the steepest markups in the catalog at 1737% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (597 here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($6.82 here).
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, the data changelog, or report a data error.