Syphilis Test
What Medicare pays for 86593, what providers bill, and how the price varies across 32 states, drawn from CMS 2023 claims data.
86593 · the short answer
For syphilis test, Medicare pays about $4.30 on average across 32 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $4.30
- Providers bill
- $31.30
- States with data
- 32
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 |
|---|---|---|
| Arkansas | $4.31 | $9.24 |
| California | $4.31 | $24.60 |
| Colorado | $4.31 | $29.89 |
| Hawaii | $4.31 | $20.45 |
| Illinois | $4.31 | $34.19 |
| Kansas | $4.31 | $36.54 |
| Kentucky | $4.31 | $7.99 |
| Louisiana | $4.31 | $23.49 |
| Maryland | $4.31 | $32.24 |
| Massachusetts | $4.31 | $22.80 |
| New Mexico | $4.31 | $91.88 |
| New York | $4.31 | $31.50 |
| North Carolina | $4.31 | $31.61 |
| Ohio | $4.31 | $31.99 |
| Oklahoma | $4.31 | $38.24 |
| Oregon | $4.31 | $25.67 |
| Tennessee | $4.31 | $42.06 |
| Virginia | $4.31 | $15.85 |
| Washington | $4.31 | $33.43 |
| West Virginia | $4.31 | $34.83 |
| Wisconsin | $4.31 | $37.45 |
| Florida | $4.31 | $35.04 |
| New Jersey | $4.31 | $31.92 |
| Georgia | $4.30 | $37.36 |
| Texas | $4.30 | $31.75 |
| Alabama | $4.30 | $32.01 |
| Pennsylvania | $4.28 | $22.25 |
| Arizona | $4.26 | $30.14 |
| Michigan | $4.16 | $18.61 |
| Nevada | $4.16 | $18.29 |
| Indiana | $4.10 | $68.00 |
| Minnesota | $4.02 | $18.52 |
What the Data Says About Syphilis Test
Across 32 states with reporting providers, CPT code 86593 (Syphilis Test) shows a national average Medicare payment of $4.30 against an average billed charge of $31.30. That gap, a 7.3x markup, or 627% 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 10.9K services billed to Medicare in 2023 by 300 distinct providers, serving 8.6K unique beneficiaries. State-level variation is significant: Minnesota reports the lowest average payment at $4.02, while Arkansas reports the highest at $4.31. At just 7%, 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 $9.64, with self-pay cash discounts commonly bringing the figure closer to $11.83. Within Laboratory, Syphilis Test ranks #490 of 502 tracked procedures by national average Medicare payment.
What to do with this
If you may have syphilis test 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 syphilis test 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 Syphilis Test cost?
Syphilis Test (CPT 86593) is priced fairly consistently nationwide: Medicare pays $4.30 on average, and the $4.02-$4.31 state range stays relatively tight. Providers typically bill $31.30.
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 Syphilis Test cost with insurance?
With commercial insurance, syphilis test costs an estimated $9.64 on average (range: $6.75-$13.50), a moderate premium over Medicare's $4.30. Without insurance, the estimated cash price is $11.83.
Which state has the lowest cost for Syphilis Test?
Minnesota and Arkansas bookend the range for Syphilis Test, at $4.02 and $4.31 respectively - a relatively tight $0.29 spread nationwide.
How many providers perform Syphilis Test?
Syphilis Test is comparatively uncommon: only 300 providers nationally billed Medicare for it in 2023, serving 8.6K beneficiaries via 10.9K total services.
What is the billed-to-Medicare markup for Syphilis Test?
Providers bill 7.3x what Medicare pays for Syphilis Test - a markup within the typical range at 627% 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.