Immunology · 86651

Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)

What Medicare pays for 86651, what providers bill, and how the price varies across 2 states, drawn from CMS 2023 claims data.

$12.81
Medicare pays
$105.79
Providers bill
8.3×
Markup
#6,977 of 9,297
Volume rank

The verdict

Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) pairs modest national service volume with a higher-than-typical markup.

25th pct.
national service volume
Top 18%
billed-to-Medicare markup
8.3×
billed vs. Medicare
$12.81
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.

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Payment tier in Immunology
Below-median in category
#139 of 225 procedures in Immunology by national average Medicare payment.
Markup tier vs. tracked procedures
8.3x markup
8.3x the Medicare rate. This procedure has too little volume for a reliable catalog-wide rank.
173
Total Services
95
Beneficiaries
36
Providers
2
States with Data

Price Range Across States

Lowest State Avg
$12.93
Texas
Highest State Avg
$12.93
California

What You Might Pay

Est. Commercial Insurance
$23.69
Range: $16.58 – $33.17
Est. Cash / Self-Pay
$38.70
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). 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

8 Among the most affordable more affordable than 82% 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%). Below this entry. 7–8: 801 procedures (9%). Below this entry. 8–9: 541 procedures (6%). This entry sits in this band. 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 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

Prices by State

State Medicare Payment Billed Charge
California $12.93 $103.27
Texas $12.93 $98.88

What the Data Says About Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)

Across 2 states with reporting providers, CPT code 86651 (Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)) shows a national average Medicare payment of $12.81 against an average billed charge of $105.79. That gap, a 8.3x markup, or 726% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.

Immunology procedures like this one saw 173 services billed to Medicare in 2023 by 36 distinct providers, serving 95 unique beneficiaries. State-level variation is significant: Texas reports the lowest average payment at $12.93, while California reports the highest at $12.93. At just 0%, 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 $23.69, with self-pay cash discounts commonly bringing the figure closer to $38.70. Within Immunology, Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) ranks #139 of 225 tracked procedures by national average Medicare payment.

Where this sits in the registry

Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) (86651) 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 Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) rank among Medicare procedures?

According to CMS Medicare Part B claims, Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) (CPT 86651) ranks #6,977 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #139 of 225 within Immunology by national average Medicare payment. See /methodology#corpus-placement.

How much does Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) cost?

Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) (CPT 86651) is priced fairly consistently nationwide: Medicare pays $12.81 on average, and the $12.93-$12.93 state range stays relatively tight. Providers typically bill $105.79.

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 Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) cost with insurance?

With commercial insurance, analysis for antibody to la crosse (california) virus (encephalitis causing virus) costs an estimated $23.69 on average (range: $16.58-$33.17), a moderate premium over Medicare's $12.81. Without insurance, the estimated cash price is $38.70.

Which state has the lowest cost for Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)?

Texas and California bookend the range for Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus), at $12.93 and $12.93 respectively - a relatively tight $0.00 spread nationwide.

How many providers perform Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)?

Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) is comparatively uncommon: only 36 providers nationally billed Medicare for it in 2023, serving 95 beneficiaries via 173 total services.

What is the billed-to-Medicare markup for Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus)?

Providers bill 8.3x what Medicare pays for Analysis For Antibody To La Crosse (california) Virus (encephalitis Causing Virus) - a higher-than-typical markup at 726% 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.

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.

Related

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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

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.