Immunology · 86705

Hepatitis B Core Antibody (igm) Measurement

Medicare Payment (avg)
$11.51
What Medicare actually pays
Billed Charge (avg)
$86.46
What providers submit
Markup
7.5x
651% above Medicare rate
44.7K
Total Services
42.3K
Beneficiaries
1.0K
Providers
45
States with Data

Price Range Across States

Lowest State Avg
$11.02
Connecticut
Highest State Avg
$11.53
Arkansas

What You Might Pay

Est. Commercial Insurance
$25.78
Range: $18.04 – $36.09
Est. Cash / Self-Pay
$32.41
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), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Immunology 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 $11.53 $27.20
Colorado $11.53 $100.59
Delaware $11.53 $17.00
Georgia $11.53 $143.49
Idaho $11.53 $59.16
Illinois $11.53 $104.34
Kansas $11.53 $124.98
Maine $11.53 $40.42
Minnesota $11.53 $152.14
Missouri $11.53 $40.12
Nevada $11.53 $126.63
New Mexico $11.53 $50.62
North Dakota $11.53 $39.68
Oklahoma $11.53 $81.95
Utah $11.53 $24.80
Puerto Rico $11.53 $13.35
California $11.53 $66.82
New Jersey $11.52 $108.16
Alabama $11.52 $85.94
Florida $11.52 $102.32
Michigan $11.51 $36.53
New York $11.51 $87.31
North Carolina $11.51 $91.86
Virginia $11.51 $49.53
Massachusetts $11.51 $104.91
Texas $11.51 $104.90
Pennsylvania $11.51 $51.99
Hawaii $11.49 $34.75
Maryland $11.49 $81.49
Ohio $11.49 $72.29
Arizona $11.47 $56.35
Louisiana $11.46 $52.38
Tennessee $11.45 $84.59
Kentucky $11.45 $29.77
Washington $11.44 $103.06
South Carolina $11.41 $56.32
Iowa $11.39 $78.52
Wisconsin $11.38 $87.56
Indiana $11.38 $78.29
Oregon $11.36 $36.19
Rhode Island $11.35 $42.67
South Dakota $11.34 $69.95
Nebraska $11.31 $25.19
Mississippi $11.27 $81.65
Connecticut $11.02 $64.58

What the Data Says About Hepatitis B Core Antibody (igm) Measurement

Across 45 states with reporting providers, CPT code 86705 (Hepatitis B Core Antibody (igm) Measurement) shows a national average Medicare payment of $11.51 against an average billed charge of $86.46. That gap — a 7.5x markup, or 651% 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.

Immunology procedures like this one saw 44.7K services billed to Medicare in 2023 by 1.0K distinct providers, serving 42.3K unique beneficiaries. State-level variation is significant: Connecticut reports the lowest average payment at $11.02, while Arkansas reports the highest at $11.53. 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 Immunology category (2.24x), the estimated commercial insurance price lands near $25.78, with self-pay cash discounts commonly bringing the figure closer to $32.41. 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.

Frequently Asked Questions

How much does Hepatitis B Core Antibody (igm) Measurement cost?

The national average Medicare payment for Hepatitis B Core Antibody (igm) Measurement (CPT 86705) is $11.51, while providers typically bill $86.46. Prices vary significantly by state, ranging from $11.02 to $11.53.

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 Hepatitis B Core Antibody (igm) Measurement cost with insurance?

With commercial insurance, Hepatitis B Core Antibody (igm) Measurement costs an estimated $25.78 on average (range: $18.04 – $36.09). Without insurance, the estimated cash price is $32.41. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Hepatitis B Core Antibody (igm) Measurement?

Connecticut has the lowest average Medicare payment for Hepatitis B Core Antibody (igm) Measurement at $11.02, while Arkansas has the highest at $11.53. This $0.51 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Hepatitis B Core Antibody (igm) Measurement?

Nationally, 1.0K providers billed Medicare for Hepatitis B Core Antibody (igm) Measurement in 2023, performing 44.7K total services for 42.3K beneficiaries across 45 states and territories.

What is the billed-to-Medicare markup for Hepatitis B Core Antibody (igm) Measurement?

Providers bill 7.5x what Medicare pays for Hepatitis B Core Antibody (igm) Measurement — a 651% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial