Pennsylvania · K1034

Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count in Pennsylvania

Pennsylvania Medicare Avg
$11.10
4% below national avg
National Medicare Avg
$11.62
All states combined
Billed Charge (PA)
$13.32
What providers submit
Est. Commercial (PA)
$24.41
National avg: $26.03
Est. Cash / Self-Pay (PA)
$11.99
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

2.7M
Services in PA
1.8K
Providers
N/A
Min Payment
N/A
Max Payment

Top Providers in Pennsylvania

Provider Medicare Services
Skippack Medical Lab, Llc $11.76 886.0K
Wellness Coaches Usa Llc $11.76 87.8K
Yogikrupa Health Llc $11.76 83.4K
Massey, Scott M.D. $11.76 59.2K

Pennsylvania Pricing in Context

In Pennsylvania, CPT code K1034 (Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count) carries an average Medicare payment of $11.10 — 4% below the national benchmark of $11.62. 1.8K providers across the state submitted claims for this procedure in 2023, performing 2.7M total services. Individual payments in PA ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.

The average billed charge in Pennsylvania is $13.32, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Pennsylvania sits below the national Medicare average, commercial rates in the state may also run lower than the US median.

Using RAND 2024 commercial-to-Medicare ratios for DME (Temporary) procedures, the estimated commercial insurance price in Pennsylvania lands near $24.41, with self-pay cash prices typically around $11.99. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.

Frequently Asked Questions

How much does Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count cost in Pennsylvania?

The average Medicare payment for Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count in Pennsylvania is $11.10, which is 4% below the national average of $11.62. Providers in PA typically bill $13.32 for this procedure.

What does Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count cost with insurance in Pennsylvania?

With commercial insurance in Pennsylvania, Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count costs an estimated $24.41. Without insurance, the estimated cash price is $11.99. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.

How many providers perform Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count in Pennsylvania?

1.8K providers in Pennsylvania billed Medicare for Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count in 2023, performing 2.7M total services. Medicare payments ranged from N/A to N/A depending on the provider.

Is Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count cheaper in Pennsylvania than the national average?

Yes — Provision Of Covid-19 Test, Nonprescription Self-Administered And Self-Collected Use, Fda Approved, Authorized Or Cleared, One Test Count costs 4% below the national average in Pennsylvania. The state average Medicare payment is $11.10 compared to $11.62 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.

Related

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