Immunology · 86713

Analysis For Antibody To Legionella (waterborne Bacteria)

What Medicare pays for 86713, what providers bill, and how the price varies across 11 states, drawn from CMS 2023 claims data.

86713 · the short answer

For analysis for antibody to legionella (waterborne bacteria), Medicare pays about $14.98 while providers bill $163.57 on average, a 10.9× markup, one of the steepest markups in the catalog. State-level Medicare rates range 1% from lowest to highest.

Medicare pays
$14.98
Providers bill
$163.57
Markup
10.9×
Markup percentile
91th

Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.

Medicare Payment (avg)
$14.98
What Medicare actually pays
Billed Charge (avg)
$163.57
What providers submit
Markup
10.9x
992% above Medicare rate
858
Total Services
646
Beneficiaries
67
Providers
11
States with Data

Price Range Across States

Lowest State Avg
$14.90
California
Highest State Avg
$14.99
Illinois

What You Might Pay

Est. Commercial Insurance
$33.55
Range: $23.48 – $46.97
Est. Cash / Self-Pay
$56.21
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.

Where this markup sits nationally

Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate

11 Among the most affordable more affordable than 91% 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%). Below this entry. 9–10: 351 procedures (4%). Below this entry. 10–11: 246 procedures (3%). This entry sits in this band. 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 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
Illinois $14.99 $242.29
Arizona $14.99 $150.69
Kansas $14.99 $235.60
Texas $14.99 $186.18
Oklahoma $14.99 $110.36
Florida $14.99 $205.96
New York $14.99 $156.02
North Carolina $14.99 $154.45
Ohio $14.99 $125.83
New Jersey $14.98 $157.27
California $14.90 $181.13

What the Data Says About Analysis For Antibody To Legionella (waterborne Bacteria)

Across 11 states with reporting providers, CPT code 86713 (Analysis For Antibody To Legionella (waterborne Bacteria)) shows a national average Medicare payment of $14.98 against an average billed charge of $163.57. That gap, a 10.9x markup, or 992% 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 858 services billed to Medicare in 2023 by 67 distinct providers, serving 646 unique beneficiaries. State-level variation is significant: California reports the lowest average payment at $14.90, while Illinois reports the highest at $14.99. At just 1%, 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 Immunology category (2.24x), the estimated commercial insurance price lands near $33.55, with self-pay cash discounts commonly bringing the figure closer to $56.21. Within Immunology, Analysis For Antibody To Legionella (waterborne Bacteria) ranks #89 of 225 tracked procedures by national average Medicare payment.

What to do with this

If you may have analysis for antibody to legionella (waterborne bacteria) 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 analysis for antibody to legionella (waterborne bacteria) 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 Analysis For Antibody To Legionella (waterborne Bacteria) cost?

Analysis For Antibody To Legionella (waterborne Bacteria) (CPT 86713) is priced fairly consistently nationwide: Medicare pays $14.98 on average, and the $14.90-$14.99 state range stays relatively tight. Providers typically bill $163.57.

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 Legionella (waterborne Bacteria) cost with insurance?

With commercial insurance, analysis for antibody to legionella (waterborne bacteria) costs an estimated $33.55 on average (range: $23.48-$46.97), a moderate premium over Medicare's $14.98. Without insurance, the estimated cash price is $56.21.

Which state has the lowest cost for Analysis For Antibody To Legionella (waterborne Bacteria)?

California and Illinois bookend the range for Analysis For Antibody To Legionella (waterborne Bacteria), at $14.90 and $14.99 respectively - a relatively tight $0.10 spread nationwide.

How many providers perform Analysis For Antibody To Legionella (waterborne Bacteria)?

Analysis For Antibody To Legionella (waterborne Bacteria) is comparatively uncommon: only 67 providers nationally billed Medicare for it in 2023, serving 646 beneficiaries via 858 total services.

What is the billed-to-Medicare markup for Analysis For Antibody To Legionella (waterborne Bacteria)?

Providers bill 10.9x what Medicare pays for Analysis For Antibody To Legionella (waterborne Bacteria) - one of the steepest markups in the catalog at 992% above the Medicare rate.

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.

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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 Editorial

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.