Cost analysis for CPT 0240U — Respiratory infectious agent detection by rna for severe acute respiratory syndrome coronavirus 2 (covid-19), influenza a, and influenza b) in upper respiratory specimen, each reported as detected or not detected
Average Medicare Payment
$139.01
2023 data
Total Payments (2023)
$27.7M
Services (2023)
198.0K
Price Change (2020–2023)
-2.5%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2020 | $142.63 | $27.5K | 193 | — |
| 2021 | $142.12 | $644.1K | 4.5K | -0.4% |
| 2022 | $139.34 | $1.9M | 13.7K | -2.0% |
| 2023 | $139.01 | $27.7M | 198.0K | -0.2% |
The most expensive state pays 1.0x more than the cheapest for this procedure. IL averages $139.78 vs WI at $137.16.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| IL | $139.78 | $20.9M | 149.7K | 7 |
| KS | $139.78 | $81.8K | 585 | 10 |
| MN | $139.78 | $34.9K | 250 | 15 |
| AZ | $139.78 | $31.6K | 226 | 4 |
| NJ | $139.78 | $27.8K | 199 | 2 |
| MI | $139.78 | $22.5K | 161 | 6 |
| FL | $139.78 | $3.7M | 26.2K | 14 |
| CA | $139.76 | $2.0M | 14.5K | 5 |
| SD | $139.57 | $77.9K | 558 | 15 |
| NC | $139.35 | $45.4K | 326 | 12 |
| VA | $139.33 | $37.8K | 271 | 5 |
| ND | $139.24 | $43.0K | 309 | 7 |
| AR | $139.11 | $69.8K | 502 | 17 |
| IA | $138.52 | $90.9K | 656 | 11 |
| WA | $138.44 | $14.4K | 104 | 6 |
| TN | $138.40 | $50.4K | 364 | 7 |
| OK | $138.06 | $76.9K | 557 | 16 |
| PA | $138.05 | $22.4K | 162 | 3 |
| OH | $137.71 | $18.6K | 135 | 6 |
| WI | $137.16 | $273.6K | 2.0K | 6 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Sinai Laboratory Corp | Clinical Laboratory | IL | $12.7M | 91.1K | $139.78 |
| Fz Medical Group Inc | Clinical Laboratory | IL | $8.0M | 57.2K | $139.78 |
| Gp Diagnostics | Clinical Laboratory | FL | $3.6M | 25.9K | $139.78 |
| Pacific Medical Labs | Clinical Laboratory | CA | $2.0M | 14.4K | $139.78 |
| Jeffrey Bahr | Internal Medicine | WI | $191.2K | 1.4K | $136.06 |
| Goat Mass Swabs Inc | Clinical Laboratory | IL | $125.2K | 896 | $139.78 |
| Cotton O'neil Clinic Revocable Trust | Clinical Laboratory | KS | $62.5K | 447 | $139.78 |
| A2cl Services, Llc | Clinical Laboratory | WI | $58.4K | 418 | $139.78 |
| Medical Laboratories Of Eastern Iowa Lc | Clinical Laboratory | IA | $45.1K | 327 | $138.01 |
| United Eg Llc | Clinical Laboratory | IL | $35.9K | 257 | $139.78 |
| Mark Rodacker | Pathology | ND | $29.9K | 215 | $139.00 |
| George Guariglia | Family Practice | NJ | $21.2K | 152 | $139.78 |
| Francis Mohan | Family Practice | PA | $19.3K | 140 | $137.78 |
| Ylab180 Inc | Clinical Laboratory | IL | $17.9K | 128 | $139.78 |
| Optima Medical Center Inc | Clinical Laboratory | IL | $17.2K | 123 | $139.78 |
| Dustin Allen | Physician Assistant | VA | $16.7K | 120 | $138.75 |
| James Gast | Family Practice | WI | $14.4K | 103 | $139.78 |
| Avera Mckennan | Clinical Laboratory | SD | $13.6K | 97 | $139.78 |
| Ernest Buchanan | Family Practice | TN | $13.3K | 97 | $137.14 |
| Hamad Ahmad | Family Practice | TN | $12.0K | 87 | $138.17 |
Based on the data, CPT 0240U shows a 1.0x variation in pricing across states — relatively consistent by Medicare standards.
Costs have decreased 2.5% since 2020. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.