Stem Cells Count, Total

What the Data Says About Stem Cells Count, Total

Across 1 states with reporting providers, CPT code 86367 (Stem Cells Count, Total) shows a national average Medicare payment of $75.03 against an average billed charge of $407.04. That gap — a 5.4x markup, or 443% 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 64 services billed to Medicare in 2023 by 6 distinct providers, serving 50 unique beneficiaries. Regional variation is limited in the underlying CMS file. 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 $168.07, with self-pay cash discounts commonly bringing the figure closer to $168.21. 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.